
Ik C 1 1- 



OIRTiglll X°_ 



rOl^liK'in IHIKISTT. 



A TREATISE 



OM 



Surgical Therapeutics 



DOMESTIC ANIMALS 



p. J. CADIOT, Prof., and J. ALMY, Adjunct 

IN THE VETERINARY SCHOOL OF ALPORT 

TRANSLATED BY 

A. LIAUTARD, M.D.. V.M. 

Dean and Professor of Anatomy, Surgery, Sanitary Medicme and ftirisprtidettce 

in the New York American Veterinary College ; Officier dii Merite 

Agricole de Fra7tce ; Member of the Societe Centrale de JMedecine 

Vetirinaire (Paris) ; Honorary Fellow of the Royal College 

of Veterinary Surgeons {London); Corresponding 

Member of the Academy of Medecine of Brux- 

elles ; Honorary JMember of the Societe 

Veterinaire d' Alsace-Lorraine, etc. 

Author of'Vade Mecum of Equine Anatomy,'" "How to Tell the Age of 
Domestic Animals,''' ''Animal Castration," ''Lameness of Horses,^* 
Translator of "Bouley on Hydrophobia,'"' of " Zundel on 
Diseases of the Foof'; Editor of the "Ameri- 
can Veterinary Review,'''' etc., etc. 




New York 
WILLIAM K. JENKINS 

VETERINARY PUBLISHER AND BOOKSELLER , 

851-853 Sixth Avenue 

1906 



LIBRARY of CONGRFSS/ 

Two Conies Received 

JUN 25 1906 

'1 CMyrielit Entry 
( jSLASS Ck!. he. No. 
\' COPY b; 



n 






Copyright, 1898, 1900, 1902, 1906, by William R. Jenkins 



A/l Rights Reserved 



printed by the 
Press of William R. Jenkins 

NEW YORK 



PREFACE 



When the Traite de T]lh^ape^ctiq^le Generate Veterinaire of 
Professor Cadiot was issued, it appeared to me that the English- 
reading practitioner, as well as the students of our veterinary- 
colleges, would be benefited by its perusal, and for that purpose I 
obtained from the author permission to translate it. 

It is thought by the translator that in undertaking to present 
the work in its English form, he should add a contribution which 
lie hopes will prove valuable, especially to the branch of General 
Surgery, which is perhaps still deficient in English veterinary liter- 
ature ; but, as no reference to American work is made in the original 
text, the translator will take the liberty to add notes, whenever in 
his estimation due credit can be inserted, in relation to what contri- 
bution he can gather from American works. 

It is possible, however, that in adding these notes some omis- 
sion may occur ; in which case it is hoped that the indulgence of 
the reader will not be refused to the author, who will have then, 
sinned without intention. 

My principal desire is to have the English-speaking profession 
benefited, and give its members an opportunity to be well acquainted 
with all the progress made in Veterinary Surgery up to this day. 

A. EIAUTARD. 



TABLE OF CONTENTS 



I.— GENERAL SURGERY 

PAGE 

Means of Restraint of Animals i 

Securing of Solipeds 2 

Restraint in the Standing Position 2 

Restraint While Lying Down 9 

Casting with Hobbles 9 

Casting Without Hobbles 17 

Restraint of Cattle 20 

Restraint of Cattle Standing 20 

Restraint of Cattle in a Recumbent Position 23 

Restraint of Small Animals 25 

"General Anaesthesia 28 

Anaesthesia of the Horse 30 

Anaesthesia with Ether 30 

Anaesthesia with Chloroform 33 

Anaesthesia with Chloral 36 

Anaesthesia with Morphine 38 

Anaesthesia of Ruminants and Swine 39 

Anaesthesia of the Dog and Cat 39 

Anaesthesia of the Monkey 4r 

Anaesthesia of Birds 42 

Local Anesthesia 43 

Anaesthesia by cold 43 

Anaesthesia by cocaine 44 

Surgical Antisepsis and Asepsis 46 

Antiseptic Agents 52 

Instruments-^— Dressing Material 56 

Technic of Antisepsy and Asepsy 57 

Hemostasis 69 

Preventive Hemostasis 69 

Hemostasis During and After Operation 71 

Cauterization — Firing 77 

Cauterization of Solipeds 79 

Cauterization of Bovines 92 



Vi TABLE OF CONTENTS 

IL— DISEASES COMMON TO ALL TISSUES 

PAGE 

Inflammation 97 

Abscess loi 

Gangrene m 

Ulcers "5 

Fistula 117 

Foreign Bodies t2o 

Traumatic Lesions 125 

Wounds from Sharp Instruments 130 

Incised Wounds i3t> 

Wounds from Pricking Instruments 132 

Punctured Wounds 132 

Contused Wounds i34 

Wounds by Fire-arms i37 

Gun-shot Wounds 1 37 

^ Torn Wounds 141 

Wounds from Bites 142 

Poisoned or Virulent Wounds 143 

Granular Wounds 148 

Subcutaneous wounds 149 

Contusions — Bruises 150 

Traumatic Effusions of Serosity or Oily Substances 152 

Chilblains — Frost-Bites — Congelations i54 

Burns i57 

Insolation — Sunstroke — Overheat 161 

Accidents from Lightning 163 

Complications ok Traumatic Lesions 166 

Syncope — Shock — Local Stupor 166 

Hemorrhage and Traumatic Anaemia 167 

Traumatic Emphysema 168 

Thrombosis and Traumatic Venous Embolism 170 

Traumatic Fever 171 

Traumatic Erysipelas i73 

Purulent Infections — Pyohemia i75 

Surgical Septicaemia. 178 

Traumatic Gangrene 178 

Putrid Infection — Chronic Septicaemia 183 

Tetanus 184 

Granulations— Cicatrices 194 

Mycosis 200 

Actinomycosis 200 

, Botryomycosis 204 



} TABLE OF CONTENTS 



vn 



PAGE 

Virulent Diseases 207 

Bacterian Anthrax 207 

Bacteridian Anthrax 208 

Farcy 209 

Tuberculosis 210 

Tumors 213 

III— DISEASES SPECIAL TO ALL TISSUES AND AFFECTIONS 
OF THE EXTREMITIES 

Diseases of the Skin and Cellular Tissue 225 

Traumatic Lesions 225 

Excoriations — Cores — Stickfasts 225 

Erythema 227 

Dermatitis 229 

Elephantiasis 237 

Acne 239 

Furuncle — Anthrax 240 

Sebaceous Cysts 24 r 

Cutaneous Horns 242 

Tumors 243 

Parasitic Affections 245 

Diseases of Serous Burs^ 24S 

Traumatic Lesions 248 

Hygromas — Bursitis 248 

Hygroma of the Elbow (Capped Elbow) 251 

„ Knee 255 

„ Stifle 257 

,, Hock (Capped Hock) 257 

,, Fetlock 259 

,, Cannon 259 

,, Withers 260 

Poll 260 

Tumors 260 

Diseases of Muscles 261 

Traumatic Lesions 261 

Ruptures 263 

Hernias — Luxations 266 

Luxation of the Long Vastus 267 

Myositis 269 

Amyotrophies 273 

Parasites — Tumors 275 

Spasms— Contractures — Cramps 276 

Springhalt 277 

Diseases of Tendons 2S4 

Contusions 2S4 



viii TABLE OF CONTENTS 

PAGE 

Diseases of Tendons {coni.) 

Wounds c 284 

Wounds of the Tendo Achillis , 287 

,, Extensors of the Phalanges , 289 

,, Flexors of the Phalanges 289 

Suppurative Tenosilis 292 

Tendinous Quittor 292 

Ruptures 295 

Rupture of the Tendon of the Infra-Spinatus 296 

„ Cord of the Flexor Metatarsi 297 

,, Tendo Achillis 300 

,, Anterior Extensor of the Phalanges 301 

„ Flexors of the Phalanges 301 

,, Suspensory Ligament 303 

Tendinous Luxations 304 

Sprains of Tendons — Nerf Ferrure — Tenositis 306 

Knuckling 316 

Sprung Knees 320 

Tendinous Helminthiasis 322 

Diseases of Tendinous Synovial Sacs 324 

Traumatic Lesions , 324 

Traumatic Synovitis 326 

Closed Acute Synovitis 327 

Infectious Synovitis 328 

Chronic Synovitis and Dropsies 330 

Synovitis of the Sheath of the Coraco-Radialis 335 

,, Sub-Spinatus 337 

Knee 337 

Large Gluteus 33S 

Hock 339 

Sesamoid Sheaths 341 

Sheath of Anterior Extensor of the Phalanges.. 343 

Diseases of Aponeurosis 345 

Diseases of Arteries 347 

Wounds 347 

Ruptures . . , 351 

Aneurisms ' 353 

Arterio-Venous Aneurisms 355 

Arteritis and Thrombosis 357 

Diseases of Veins 361 

Traumatic Lesions 361 

Thrombus 363 

Phlebitis and Thrombosis 364 

Varices 367 



TABLE OF CONTENTS ix 

PAGE 

Diseases of Lymphatics 369 

Contusions — Wounds — Fistulas 369 

Lymphangitis 370 

Traumatic Lymphangitis 37r 

Specific Lymphangitis 375 

Adenitis 377 

Tumors 379 

Lymphangiectasis 380 

Diseases of Nerves 382 

Traumatic Lesions 382 

Neuritis 390 

Neuromas 392 

Neuralgias 395 

Paralysis 396 

Paralysis of the Sus-scapular Nerve 401 

,, Brachial Plexus 402 

, , Radial Nerve 403 

, , Obturator Nerve 407 

„ Femoral Nerve 407 

,, Great Sciatic Nerve 410 

,, External Sciatic Popliteal 410 

Diseases of Bones 412 

Contusions 412 

Wounds 413 

Fractures 414 

Incomplete Fractures 414. 

Complete Fractures 415 

Open Fractures 429 

Fracture of the Scapula 432 

Humerus 435 

Radius 437 

Cubitus 440 

Carpus 441 

Ossa Innominata 442 

Femur 444 

Patella 446 

Tibia and Fibula 447 

Tarsus 449 

Metacarpus and Metatarsus 450 

Phalanges 452 

Sesamoids 454 

Periostitis— Osteitis — Osteomyelitis 455 

Caries — Suppurative Osteomyelitis 4';9 

Necrosis 461 

Exostosis 465 

Osselets 468 

Spavin — Tarsal Osteo-arthritis 469 

Jarde 474 



X TABLE OF CONTENTS 

PAGE 

Diseases of Bones {cont.) 

Curbe ■« 475 

Splints 476 

Ringbones — Sidebones — Phalangeal Exostosis 478 

Rachitism 484 

Osteomalacia — Osteoclastia — Osteoporosis 487 

Tumors 489 

Hydatids 490 

Diseases of Articulations 491 

Contusions 491 

Sprains 491 

Sprain of the Scapulo-humeral Joint 494 

„ Shoulders 494 

Knee 497 

,, Coxo-femoral Joint 497 

Stifle 498 

,, Hock 498 

,, Fetlock 499 

,, Phalanges 502 

Luxations 503 

Luxation of the Shoulder 506 

„ Elbow 508 

,, Knee 510 

„ Pelvis 510 

,, Coxo-femoral Joint 511 

„ Femoro-tibial Joint 514 

,, Femoro-patellar Joint 515 

„ Hock Joint 516 

„ Fetlock Joint 517 

„ Phalangeal Articulations 520 

Pseudo-luxation of the Patella 520 

Wounds of Articulations 523 

Peri-articular Wounds 523 

Penetrating Wounds 524 

Traumatic Arthritis 533 

Articular Wounds and Traumatic Arthritis of Extremities 535 

Wounds of the Scapulo-Humeral Joint ; 535 

Humero-Radio-Cubital Joint 536 

Knee Joint 537 

Femoro-Tibial Joint 539 

Hock Joint 540 

Fetlock Joint 541 

Phalangeal Joint 542 

Closed Idiopathic Arthritis 545 

Infectious Arthritis 546 

Articular Rheumatism 548 

Arthritis of Milch Cows 549 

Post-Partum Arthritis 549^ 

Arthritis of New-Boms 552 



TABLE OF CONTENTS xi 

PAGE 

Diseases of Articulations ( cont. ) 

Hydarthrosis 554 

Hydarthrosis of the Scapulo-Humeral Joint 561 

,, Elbow Joint 561 

,, Carpal Joint 562 

Articular Thoroughpin ot the Knee 562 

Hydarthrosis of the Coxo-Femoral Joint 563 

,, Femoro-Tibio-Patellar Joint — Patellar Thor- 
oughpin 563 

,, Tarsal Joints — Articular Thoroughpin of the 

Hock 565 

„ Articulations of the Fetlock and Foot — 

Articular Windgalls 566 

Dry Arthritis — Arthritis Deformans 567 

Arthropathies in Nervous Afiections 569 

Foreign Bodies 570 

Ankylosis 572 



TABLE OF ILLUSTRATIONS. 



FIG. ^ PAGE 

1 Foot raiser (Trasbot) 4 

2 Hind limb lifted and carried forward by means of the kicking strap. . 5 

3 Contention of the hind limbs 6 

4 Hippo-strap 7 

5 Place's volta-faradic apparatus - 8 

6 Vinsot's apparatus 9 

7 Throwing of a horse 10 

8 Throwing of a horse at the Berlin College 1 1 

9 Throwing of a horse with foot-lift 12 

10 Right fore limb carried upon corresponding hind limb 13 

11 Right hind limb carried upon correspondmg fore limb 13 

12 BracyClark hobble 14 

13 English hobbles 14 

14 Denenbourg improvised hobble 15 

15 Suykerbuyck's hobbles 16 

16 Throwing by the Russian process 17 

17 Throwing with two side lines 19 

18 Daviau's apparatus • 19 

19 Contention of a fore limb (cattle) 20 

20 Hind limb fastened at a bar 21 

21 Hind limb fastened at a bar held by two assistants 22 

22 Fastening of one fore and one hind limb 22 

23 Throwing of an ox 23 

24 Snuffer nippers 24 

25 Nasal ring 24 

26 Leading stick (Roland) 25 

27 Inhaler for etherization or chloroforming 32 

28 Richardson's atomizer 44 

29 Bistouries with metallic handles 59 

30 Reverdin's needle 60 

31 Larger's needle 60 

32 Lamblin's needle 60 

33 Lucas-Championniere's atomizer 68 

34 Preventive hemostasis. Rubber ties applied above the knee and 

hock 70 

35 Chassaignac's ecraseur 72 

36 Forceps 75 

37 Lines, dots and sharp pointed firing irons 80 

38 Bourguet's cautery 8r 

39 Paquelin's cautery 82 

40 Zoocautery 83 

41 Paquelin de Place's cautery 84 



XIV TABLE OF ILLUSTRATIONS 

FIG. PAGE 

Eolipiles 85 

Cauterization of the principal regions where firing is generally applied 86 

Subcutaneous cauterization 91 

Bead firing irons 92 

Horny cheloid of the left fore leg 196 

Autoplasty of the broken knee 198 

48 Actinomycosis of lower maxillary 201 

/^9 Actinomycosis of the tongue 201 

50 Actinomycosis bovis, magnified 203 

51 Botryomycosis of the shoulder and chest 205 

52 Botryomycosis of the tail 205 

53 Discomyces equi 206 

54 Tuberculous tumor of the periocular regions 210 

55 Tuberculous tumor of the wing 211 

56 Horny growth on a tuberculous surface of the cheek 211 

57 Shoeboil 252 

58 Hygroma of the knee 255 

59 Hygroma of the knee in a cow 256 

60 Hygroma of the knee, partly ossified and covered with horny growth 256 

61 Capped hock 258 

62 Fascia 'ata and long vastus in bovines 268 

63 Horse affected with springhalt 277 

64) 

65 y Tendinous sutures , 286 

66 J 

67 Section of the Tendo Achillis 288 

68 Fibrous tumor developed after a contused wound of the flexor 

tendons of the phalanges 290 

69 Apparatus to support the fetlock in cases of section of the flexor 

tendons of the foot 291 

70 Rupture of the cord of the flexor metatarsi 298 

71 Rupture of the tendons of the flexors of the phalanges 302 

72 Suspensory ligaments, carpal band, perforans and perforatus 308 

73 Median neurotomy 313 

74 Neurotomy of the sciatic 314 

75 Colt affected with knuckling on both fore legs 315 

76 Orthosome of Brogniez 317 

77 Knuckling and phalangeal periostitis 318 

78 Part of the fore arm and knee (posterior face) 32 r 

79 Dieulafoy's aspirator 332 

80 Potain's aspirator 333 

81 Horse aflfected with bicipital synovitis 336 

82 Tarsal thoroughpin 339 

83 Windgall of the great sesamoids 342 

84 Anterior windgall of the fetlock 343 



85) 



86 } Wounds of arteries 348 

87) 

88 ) 

g y Torsion of arteries 350 

90 Direct suture 389 



TABLE OF ILLUSTRATIONS XV 

FIG. PAGE 

91 Perineurotic suture _ 389 

92 Paralysis of the sus-scapular nerve 401 

93 Complete paralysis of the radial 404 

94 Paralysis of the radial, recovering 406 

95 Paralysis of the femoral nerve 409 

96 Paralysis of the external popliteal sciatic nerve 411 

97 Apparatus of Relier 424 

98 Bandage for fractures of the scapula and for those of the humerus . . 433 

99 Dog suflfering with osteoporosis of the legs . » 457 

100 Necrosis of the scapula 463 

loi Spavin seen from forward, left leg 470 

102 Spavin seen from behind, right leg 470 

103 Spavin ; front view of dissected hock 471 

104 Vertical transverse section of a spavined hock 471 

105 Cunean tenotomy 473 

106 Jarde 475 

107 Curb 475 

108 Phalangeal ringbone , 479 

109 Side bone with atrophy of the third phalanx 479 

no High neurotomy , 482 

111 Rachitic goat 485 

112 Stifle joint 521 

1 13 Femoro-tibio-patellar arthritis 550 

114 Hydarthrosis of the elbow 561 

115 Hydarthrosis of the knee 562 

116 Hydarthrosis of the fetlock 566 

117 Dry arthritis of the stifle joint , 568 

iiS Dry arthritis of the stifle joint * = ....,.. 571 



FIRST PART 



TREATISE 

ON 

VETERINARY SURGICxiL THERAPEUTICS 



FIRST PART 

GENERAL SURGERY. 



MEANS FOR THE RESTRAINT OF ANIMALS. 

Since all tissues, with the exception of those of epidermic or epi- 
thelial nature, are provided with sensitive nerves, almost all opera- 
tions are painful, and give rise on the part of the animal to reactions 
which are dangerous for the operator, his assistants, or the patient 
itself. Under the influence of the pain produced by the instrument 
no animal will remain quiet. It will resist and try to defend itself, 
so that the surgeon who wishes to act with safety must take precau- 
tions against injury. The horse with his feet or teeth, the steer with 
his horns or his legs, the dog and the pig with their teeth, the cat 
with its claws and canines, may inflict dangerous wounds. 

A number of veterinarians have paid with their life for their neg- 
ligence and lack of precaution in providing nieans for the control of 
large animals. Generally means of restraint must be employed. 
Yet, with kindness, caresses, and patience, one may succeed in con- 
trolling an animal, which threats and pain would only exasperate 
and possibly render more dangerous. Rough handling and inflic- 
tion of great pain have often caused serious accidents. It is on 
account of such treatment that a great many horses hurt, disable, or 
kill themselves, and that too many men become victims of their own 
unskilfulness and their own brutality. (Bourgelat. ) 

It is preferable to fasten the animal standing, even if the restraint 
of a recumbent position allows an easier surgical operation. Such a 

T 



2 VETERINARY SURGICAL THERAPEUTICS. 

position also suggests the possibility of strong reactions, which may- 
be the cause of fractures of the vertebral column or of a bone of the 
extremities, of paralysis or various other accidents of a serious 
nature. The victims of a "forced recumbent position are not now 
taken into account. 

Only slightly painful operations, or those required for internal dis- 
eases, should be performed in the stable. Not only is this place, 
ordinarily, badly lighted, but there is danger of the operators being 
squeezed against the wall or the partitions of the stall. It is better 
to select, close by, a convenient place (grass or soft ground), which 
should be covered with straw. On pavement, or on a hard and slip- 
pery surface, the horse is liable to slip and injure its knees. 

As it is important to see well what one is doing, operations should 
be performed by daylight. Bothersome, curious, and useless wit- 
nesses would better be kept away. One should take a good posi- 
tion for avoiding injuries from the patient. At night lamps are used 
to lig-ht the place used for the operation. 

I. 

SECURING OF SOLIPEDS. 
Restraint in the Standing Position. 

When a horse is to be held in hand it should have on a bridle or a 
halter. If the latter is used, better control is obtained if a rope passed in 
his mouth rests upon the bars. In some cases the cavesson is use- 
ful. At times, for operations performed in certain regions, the ani- 
mal is tied to a ring or a post with an ordinary halter or one still 
stronger. The rope of this should never be left in the mouth or over 
the animal's nose, as the horse, pulling backwards, may injure its 
tongue or fracture its jaw. The bit or the bridle should not be used, 
since they are likely to give rise to the same accidents. 

After the animal has been thus prepared it may be possible, by 
kind treatment, as well as by these means of restraint, to obtain a suf- 
ficient submission on the part of the animal to perform a compara- 
tively painless operation. But many horses are so restless that vio- 
lent measures must be resorted to. Often applying the old aphorism, 
"that of two simultaneous pains, not in the same spot, the more 
severe renders the other less apparent," the " hvilch " is used. Is it 
for a simple incision, a free counter-opening, the lancing of an 
abscess, the exploration of a fistula, or the removal of a small neo- 
plasm, the "twitch" is applied to the upper lip, and the pain 
resulting from its t wistings is such that the animal does not react under 
that produced by the instrument. Applied to the ear, or to the lower 
lip, this revulsive does not act so well. The assistant who holds the 



SECURING OF SOLIPEDS. 3 

"twitch" places liimself in front of the patient, a httle towards the side, 
to avoid kicks from the fore legs. A "twitch" can be made readily 
with a piece of rope and a small stick. " Bar?iacles " are used for 
the same purpose. Two rods of iron or of wood, fastened together 
at one end with a hinge or a rope, are placed on the upper lip, 
embracing it ; then they are brought together and secured by a ring 
or a cord at the other end. The " Polish barnacle," also called " Ger- 
man bit," is advised when the application of the twitch is difficult, 
because the horse resists, kicks, or bites. It is made of a cord some three 
or four meters long, having at one end a small loop or a ring. A large 
loop is made in passing the cord into the mouth, over the poll, and 
again through the ring. A more or less vigorous pull on the cord will 
proportionately distend the commissure of the lips, compress the 
cheeks, and produce much pain. The cord can also be made tight 
by twisting it with a piece of stick. Some authors advise inserting 
the finger or a bullet of lead in the ear. Gohier relates the case of a 
celebrated stallion which could not be shod without having in his ears 
bullets held together with a string. Many dangerous animals be- 
come quiet when they are temporarily blinded with a ' ' cap " made of 
cloth or leather, or by simply having the head covered with an apron. 
To the horse that bites or defends himself with his teeth the 
"muzzle" is appHed. This may be replaced by a cord round the 
lower part of the head, passing over the nose, and twisting round the 
neck of the inferior maxillary bone ; this is an excellent device. 
The ''^cradle'' or "side bar" is advantageous in preventing an ani- 
mal from biting the lateral parts of the trunk, the chest, or the fore 
legs. 

In some cases, when one operates on the fore legs, the anterior 
regions of the trunk, or the head, it is prudent to have this last held 
downwards by one or two assistants. A cord or a leather strap fas- 
tened to a halter is sometimes used, passing it between the fore legs, 
through a ring of the surcingle and then back again to the ring of the 
halter, where it is secured. The head should be held upwards, if one 
operates on the hind quarters of the animal. 

Raising one leg of an animal reduces his base of sustentation and 
renders it difficult for him to strike or kick. To raise a front foot, 
one takes hold of the canon, flexes it on the forearm, and keejis it 
in that position with both hands round the coronet — or holds it 
simply by grasping the toe with one hand, the thumb resting on the 
sole or the arch of the shoe and the lingers on the wall of the foot. 
Ordinarily, a strong assistant can easily do this, especially if the 
twitch is used. But if the horse resists, moves constantly, or if the 
operation lasts some time, the strap or the plaie-longe \s employed. 
The use of the former is common to all blacksmith shops ; its advan- 
tages are well known. With the plate-longe, the foot may be 



VETERINARY SURGICAL THERAPEUTICS. 



secured in various ways : ist, fixed round the pasterns, it is carriecj 
up to the withers, round the thorax, back under the canon of thf,- 
foot, raisedj and pulled on horizontally ; 2d, fixed on the coronet 
and the canon flexed on the forearm, it is rolled round both of these 
and its extremity held by an assistant. 

Instead of the plate-longe, one may use the foot-raiser. It is 
made of a wide strap some 0.60 centimeters long, having a 
buckle at one of its ends and a number of holes at the other, thus 
making firm the knee flexed on the forearm and rendering them im- 
movable, so that the animal cannot strike with his foreleg. A long 
leather strap or a single rope may replace the foot-raiser. The one 
invented by Trasbot consists of a leather strap about i meter 20 cen- 
timeters long, pierced with holes, having at one of its ends a flat 
ring and on one side, at about 25 centimeters from the ring, a buckle. 

The strap running through the ring- 
^ y — -T \ /^JHP'''''"^^i^ forms a loop fixed on the coronet; 

f j £S^ ^m . then is wound around the forearm, 

passing from the inner to the outer 
surface, where it is secured by the 
buckle (fig. i). With the foot-raiser, 
horses soon get tired of struggling, 
and can be easily approached. 

To raise a hind leg, more streno-th 
and skill are necessary. The as- 
sistant, placed on the side of the 
leg to be raised, passes his hand 
from the back forwards on the in- 
ner face of the canon ; by a gradual 
traction upon the leg he raises it 
from the floor, then resting it on his 
thigh holds it with both his hands 
around the coronet. To hold the 
foot, sometimes a rope tied to the 
tail and passed vmder the flexed 
coronet is used in preference. For 
the anterior legs, a strap or the 
plate-longe is used. The former, 
placed around the neck, secured by 
a straight knot, and carried backwards along the spine, is twisted 
around the base of the tail, then round the coronet, when by a back- 
wards traction the leg is raised. It is preferable, in using this last 
mode (the plate-longe), to place a hobble round the coronet, and to- 
•pass the rope through the ring of the hobble. 

It is also with the assistance of the plate-longe that one of the hind' 
legs may be carried forward. Fixed to the canon or to the coronet 




Fig. I — Foot raiser (Trasbot.) 



SECURING OF SOLIPEDS. 



5 



"by a slip knot, it is carried forward between the forearms, passed 
round the opposite shoulder, brought to the withers along- the ribs 
to the elbow, where, made to cross itself from within outwards, it 
is given to an assistant to hold. A sufficient pull on the rope will 
raise the leg from the ground and carry it forward (fig. 2). The 
patient is thus prevented from kicking with either of his legs. 

Surrounding the base of the neck with a loop of the plate-longe 
secured with a straight knot, in order to avoid pressure upon the 




Fig. 2. — Hind limb lifted and carried forward by means of the kicking-strap. (From a photograph.) 

trachea, then carrying its free end between the hind canons, 
passing it round the coronet of the leg to be raised, and bringing it 
l)ack to the elbow to cross, is not a thing to be recommended : if 
the animal struggles, the rope may bruise or chafe the skin of the 
coronet, or even the subcutaneous tissues. 

To immobilize the two hind legs, two hobbles are used, one single, 
the other, the king hobble ; these are placed round the hind coro- 
nets, the ring turned forward and the chain or rope of the main hob- 
ble passed through the ring of the other. It is stayed with a knot or 
in the usual way, and then its free end is carried forwards between 
■ the fore legs, around one or the other of the shoulders, to the back, 
to the sides of the chest, and to the e'lbow, where, crossing itself from 
within outwards, it is entrusted to an assistant (fig. 3). 

There are other devices : Put upon the horse a surcingle having- 
two rings on its outer surface, one on each side of the vertebral col- 
umn, take two strong ropes or plate-longes, fix them at one end 
round the coronets, pass them forward through each corresponding- 



6* 



VETERINARY SURGICAL THERAPEUTICS. 



ring of the surcingle, and tie them at the head on the nose band of 
the halter or of the cavesson (Keller). Put hobbles on the hind coro- 
nets, pass each of the ropes round the superior part of the corre- 
sponding forearm and tie them together over the withers. 

The " Ze Goff hobble" allows the immobilizing of either fore or 
hind quarter. In the former case, the apparatus, which has the 
shape of a Y, is fixed to the two fore and one of the hind coronets. 
If one operates on the hind quarter, the two posterior coronets and 
one anterior are secured in the slip knots of the apparatus. 




Fig. 3. — Contention of the hind limbs. 

To limit the movements of the two legs on the same side of an 
animal, both can be secured with two of the branches of the Le Goff 
hobble, or with a rope or strap having a slip knot at each end. 
(Chelchowsky. ) 

The Hippo-ldsso or lasso-breaker 0/ Raabe and Lunel, a kind of 
strait-jacket for animals, is composed of a Dutch collar and a 
breeching which can be brought close together by two lateral straps, 
so as to diminish, at will, the base of sustentation of the animal 
(fig. 4)- In pulling the straps tight, the possibility of the displace- 
ment of the extremities is limited, and even prevented, if the tighten- 
ing is sufficient to threaten the animal with a fall. The advantages 
of this apparatus are already well known, and nothing can be added 
to what has already been said by Lecoq, Rey, Bouley, and many 
others. It can be replaced by an ordinary plate-Ionge or two ropes 



SECURING OF SOLIPEDS. 7 

or straps. The plate-longe is passed around the animal, at the 
height of the superior part of the forearms and above the hocks, and 
secured, the two ropes or straps thrown over the withers, and the 
loins are tightened to it on both sides. (Butel. ) 

The electric hit, invented' by de Place, to render the shoeing of 
restive horses easier, could also be utilized to assist in the perform- 
ance of other operations in the standing position. 

It is composed of a box containing a chloride of ammonium pile, 
a graduated interrupting inductor bobbin, conductors to carry a 
communication between the bobbin and the mouth of the horse, and 
a special bit. 




Fig. 4. — Hippo-strap. — B, B', b, buckles; L, tliong, its end being attached to the breeching. 



It is a volta-faradic apparatus giving inductive currents (fig. 5). 
*'The pile is connected by a commutator D to the thread of the bob- 
bin, whose induction is carried to the bit through the medium of the 
two collectors of currents A and B. The bobbin thus gives currents 
of induction which are repeated as many times a minute as the 
interruptor I oscillates in the same time. A special apparatus, consist- 
ing of a commutator button E and a third collector of currents C, 
allows the operator to vary the number of shocks, the intensity of 
which in both cases is regulated by means of an induction coil 
with a graduated tube F, which gives a stronger current the further 
it is removed from the bobbin. All that is required to put the in- 
strument in action is to move the commutator D upon its vertical 
axis in such a manner that its metallic end will rest on the button H. 
If the interruptor or current breaker does not at once do its work, it 
can be made to vibrate gently with the finger; and its motions will 
then continue. 

"To use this apparatus, a cavesson is placed on the horse's head, 



8 



VETERINARY SURGICAL THERAPEUTICS. 




Fig. 5. — Place's volta-faradic apparatus 



held by a strong man, the bit put into the animal's mouth, and con- 
ductors, which at their other end are secured in the holes of the col- 
lectors A and B, attached to the extremities. The commutator D is 
turned on, and the operator, holding the instrument in his left arm, 

watches the motions of the an- 
imal, which may give him a 
notion of what to expect. The 
first shock is given by pressing 
the button E. The animal 
rears, backs, while the assist- 
ant, following it in its move- 
ments, firmly but without jerks 
pulls on the cavesson. At the 
slightest show of resistance he 
gives a second or a third shock 
as the case may require." 
It. often happens that after this the animal remains quiet. If it 
resists, the conductors are attached to B and C, and the graduating 
tube drawn away to a greater or less distance. The continuous cur- 
rent can be stopped or allowed to go on by movements of the com- 
mutator D. 

While most high bred animals will be subdued by the first shock, 
even when it is very light, some of common, low breed, and of un- 
usual viciousness, will stand all the strength of the current and 
become submissive only after several shocks. 

We shall not here describe the ordinary posi stocks, whose first 
types go back to the days of Greek hippiatres. They are found 
more or less everywhere. They immobilize the patients well, pre- 
vent lateral movements, falls on the ground, and injuries to assist- 
ants and operators. Though little used in Germany they find great 
favor in France. In the absence of stocks, Lucet recommends a 
contrivance very practical in country districts — a two wheeled 
truck, firmly blocked to prevent its moving, and with the shafts well 
secured at a proper height. Into this the horse is introduced be- 
tween the shafts head first and securely tied, while a bar placed 
transversely behind his haunches maybe used to fix one of his legs, 
as is done in the post stocks. 

Vinsot has invented an advantageous moving stock, which permits 
of an operation being performed in the standing or the recumbent 
position (fig. 6). To place the horse in those stocks, open by re- 
moving the horizontal bar (b), which is returned to its place when 
the animal is in. The head is fixed to the front upright posts ; under 
the chest an apron is stretched, carrying two prolongations, which, 
passed between the posterior legs, support the hind quarters. The 



SECURING OF SOLIPEDS. 



feet are fixed with hobbles to a metallic chain (c) resting on the 
ground, in the axis of the apparatus, and stretched by a crank. The 
anterior legs may be attached to the side bars, the posterior to the 




Fig. 6. — Vinsot's apparatus. 

posterior transverse bar by the means of the crank. For castration 
standing, the left hind leg is carried backwards, the operator bending 
down under the left flank. Setons, opening of abscesses, dental opera- 
tions, firing on small surfaces, thinning of the horn, several opera- 
tions upon the foot, and their dressings are easily performed with 
this apparatus. {See. Recueil de Medecine Veterinaire, 1892, page 72.) 

De St. Maurine, an army veterinarian, is the inventor of a wooden 
moving stock, of easy construction, and less costly, with which an 
animal can be secured standing, or lying down, as in the Daviau 
bed. 

There are many other means of restraint — the list is very long. 
The simplest, however, are the best. The animal is brought to the 
place where it is to be operated upon, its head is covered with a cap ; 
a twitch is used to distract its attention ; a fore or a hind leg is 
raised ; if all this fails, the animal is to be secured in the recumbent 
position. 

Restraint While Lying Down. 



CASTING WITH HOBBLES. 



When the operation is to last some time, is painful, or demands an 
immobility as complete as possible, the animal is thrown down. 
\x\ the country, this is done ordinarily upon a straw bed sufifi- 



lO 



VETERINARY SURGICAL THERAPEUTICS. 



ciently thick to prevent fractures from falling. Frequently it is done 
in afield close to the stable, in a yard, under a shed, where is made a 
straw bed of variable thickness, according to the hardness of the 
ground upon which the animal is to fall. 

Restraint upon a straw bed is objectionable, since it makes perfect 
asepsis of the wounds difficult ; on that account special mattresses 
are recommended. That of Merle, which we employ, is formed of 
four sacks of impermeable cloths, filled with straw and measuring 
three meters in length by sixty centimeters in width and hooked 
together with covered hooks. When the animal is to be turned 
over, the sacks upon which the legs are resting are unhooked and 
placed on the other side of the mattress where the animal will rest. 
The disinfection is easy, the cost of the apparatus trifling. A 
simple awning stretched over the straw bed has the same advantages. 




Fig. 7.— Throwing of the horse. Common process. (From a photograph.) 



The horse, with an empty stomach, the head held with a bridle 
or a strong halter and covered with a cap, is brought near the bed 
and held by an assistant. The hobbles, with buckles converging, are 
placed on the four legs— the main hobble fixed on the anterior 
leg opposite the one on which the animal will lie. The chain of the 
hobble is then passed through the ring of the hind leg of the same 
side, then through that of the two others and brought back to the 
king hobble. A plate-longe is passed round the body, back of the 
withers. Two assistants hold its extremities. Another grasps the 
tail to pull on it in the same direction as those on the rope of the 
body (fig. 7). In order that the animal may not fall too heavily. 



SECURING OF SOLIPEDS. 



II 



the legs are brought close together by backing, or by carrying the 
hind legs forward. The chain is put on the stretch by the steady 
pull of three or four assistants. At a given signal, a common action 
takes place, the legs are brought together, and the animal, feeling 
its threatened fall, bends its legs, while the traction on the trunk, the 
tail, and the head bears down the mass of the body. When the 
horse is cast the head should immediately be stretched out lying 
down. 

The chain of the hobbles is secured by a fastener of any kind, or a 
padlock passed through one of the links. 




Fig. 8. — Throwing process in use at the Berlin College. (Moller.) 

The apparatus of Bernadot and Butel (fig. 7), has proved advan- 
tageous in keeping the head and neck extended, and preventing the 
arching of the vertebral column and violent struggling. 

The process used at the surgical clinic of Berlin differs from the pre- 
ceding in the manner the plate-longe is placed ; this has in its 
middle a wide loop passed under the shoulder of the leg opposite 
to the side on which the horse is to be thrown (fig. 8), the straw bed 
being covered besides with a wide leather mattress. 

When one has to deal with an irritable or very strong animal 
which has been cast for operations on previous occasions, he must 



12 



VETERINARY SURGICAL THERAPEUTICS. 



act quickly. As soon as one hobble is put in position, those 
■animals will become nervous, kick, and be more or less dangerous to 
-approach. It is for them that Trasbot recommends the use of the 
foot-raiser, which is placed on the fore leg opposite to the side upon 
which the animal will fall. When once this is in place, the animal is 
made to go round the straw bed once or twice. He resists, rears, 
struggles, but soon submits himself to the placing of the hobbles. 
The chain of the king hobble, which has been placed on the hind 
leg of the side of the secured fore foot, is then run through the ring 
■of the hobble of the other hind foot, then round that of the fore leg, 
which is on the ground, and brought back to the king hobble 




Fig. 9.— Tlirowing with the foot-lift. 



(fig. 9). The horse is cast with three hobbles, the foot held by the 
foot-raiser remaining free. 

Thus thrown, the horse reacts less, his struggles are less violent, 
there is less possibility of fractures by muscular contractions. 

It is often necessary to change the position of a leg. For opera- 
tions of the inguinal region, the upper hind leg is carried forward 
and secured on the corresponding shoulder. A side line fixed to the 
coronet or the fetlock is carried toward the withers, then under the 
neck, brought back to the inferior part of the -leg from below up- 
wards, and then in the direction of the croup. 

To operate with more facility in the inguinal region (hernia, cryp- 
torchidy), the upper hind leg can be carried in excessive abduction as 
follows : Two side lines fixed on the canon .are passed through, 



SECURING OF SOLITEDS. 



IS 



rings sealed in the wall, or round solid posts secured to the floor, 
and are pulled, one in the direction of the withers, the other per- 
pendicularly to the vertebral column. 




Fig. lo.— The right fore limb is carried upon the corresponding hind hmb. (From a photograph.) 

If one fore leg has been displaced and secured on the superficial 
hind one, the side lines fixed to the canon of the first are carried to 
ward the lower part of the leg, passed over and under it, then for- 




Fig. II.— The riglit hind limb is carried upon the corresponding fore limb. (From a photograph.) 

w^ard, twisting round the forearm, first under and then over it, the 
assistants pulling on the side lines when the foot is out of the hob- 
ble, as in fig. ID. Then the leg is secured by two figure 8 twists. 
and a circular knot. 

If it is a hind leg- which is to be carried forward, the side line fixed 
upon its canon is passed round the lower third of the forearm, over 



14 



VETERINARY SURGICAL THERAPEUTICS. 



and under, brought back on the leg and drawn by two assistants to- 
ward the croup. Another side line stretched above the knee assists 
considerably the manipulation. (Fig. ii.) 




Fig. 12 — Bracy-Clark's hobble 

With a figure 8 twist above the knee or above the hocks, the fore 
leg or hind leg being secured, can be carried either forward or back- 
ward with a side bar. 

To place the animal on his back, the chain, passed into a ring or 
to pulley above, is pulled upon and held by two or three assistants. 




su^*"" 



Fig. 13— English hobbles,— A, disconnected hobble; b, e, long strap; i, n, short strap; a, buckle 
with its tongue.— C, appearance of the hobble when fastened in its place.— B, king hobble; c, 
key.— E, swivel hook. (Peuch and Touissant) 

The animal can be held in the same position with a bar passed be- 
tween both fore and hind legs and held up by assistants, who sup- 
port it perpendicularly to the axis of the body. 

T@ remove the hobbles, the surgeon and one assistant, placed a 
little beyond the reach of the extremities, unbuckle those of the 
lower fore and hind legs and then those of the upper. This must be 



SECURING OF SOLITEDS. 



15 



done simultaneously and without any abrupt motion, which might 
cause the animal to struggle. 

The modification found in the Chedhomme improved hobble facili- 
tates this removal, but wants security. The majority of veterina- 
rians prefer the English hobbles as being superior. 

These admit of much easier removal than the French hobbles, which 
require more unbuckling. The hobbles of Bracy Clark are like the 
ordinary ones, but the chain of the main hobble is fixed to it by a 
movable screw, which, once removed, leaves all the hobbles loose. 

(Fig. 12.) When the ani- 
mal gets up it has them 
round each coronet, from 
which they can be read- 
ily taken off. With the 
more recent English hob- 
bles (fig. 13), the legs be- 
come free at once because 
of the manner in which the 
hobble is made — viz. , of 
two leather straps of un- 
equal length united inta 
one piece by a buckle at 
one end, and each carry- 
ing at the other end an 
eye of different shape and 
size. That of the longj- 
strap is somewhat square 
and made to allow the 
introduction of the elong- 
ated ring of the short strap 
when the hobble is placed 
round the leg. The animal is cast in the same way, the chain 
secured as above described; and when he is to be made free the 
screw of the main hobble is removed, the chain gets loose, the 
hobbles drop off themselves or are kicked off by the animal 
when he attempts to rise. Sometimes he throws them off from his 
hind legs with much force and not without danger to the lookers on. 
Bourquet's hobbles possess the same advantages. 
Denenbourg has made hobbles "economical and easy to carry." 
(Fig. 14.) Take four iron rings, four pieces of cord, and a chain. 
The rings are fixed with the cords round the coronets of the four 
legs, turning backwards for the front and forwards for the hind legs, 
as in figure 14. The animal is thrown and secured as with the ordi- 
nary hobbles. 

Suykerbuyck has a very simple set of hobbles, which Degive 




Fig. 14. — Denenbourg's improvised trammel (Peuch and 

Toussaint.) 



i6 



VETERINARY SURGICAL THERAPEUTICS. 



described as follows : Each hobble (fig. 15, A, B, C) is formed by- 
several cords braided together, or by a single one, as large as a large 
lead pencil, folded in two. These being twisted, are tied together in 
a simple round knot. This double cord should measure about 75 
centimeters in length. A ring is fastened to the loop formed by 
the folding of the cords with several twists of a small, stout string. 
Figs. BandC show how the hobble is to be placed on the leg of the 





A B C 

Fig. 15 — Suykerbuyck's hobbles. (Degive.) 



animal. This can be done in two ways : ist, the hobble, made 
as in B, is fixed on the leg by passing the ring through the double 
loop b ; 2d, the open hobble, as in A, is put against the inner face 
of the coronet, the ring turned backward (front leg) or forward (hind 
leg) ; then, after passing the cord near the ring so as to form the 
double loop b, the single cord a is brought back on the stopper knot 
n. The set is easily removed, the legs being brought together to 
relax the hobble. One hand is sufficient to make the loop a slip over 
the knot 11, and thus free the leg which was fastened. The Suyker- 
buyck hobble forms a kind of slip knot, which can be adapted to 
all coronets, no matter of what dimensions. It is long enough for a 
big horse, and can also be applied to a small one, a colt, or a pony. 



SECURING OF SOLIPEDS. 1/ 

Improvised hobbles may also be used for small animals. Four 
pieces of strong- cord are fixed on the coronets with a simple knot, 
leaving sutiticient space between them and the skin to run a ropo 
through, which takes the place of the chain. 



CASTING WITHOUT HOBBLES. 

By the Rohard process, a long cord or two side lines tied end to 
end are necessary. At about two and a half meters from one of the 
extremities a slip knot and a stopper knot are made so as to make 
this part of the cord represent a kind of loop. If a horse is to be 



Fig. i6. — Throwing by the Russian process. 

thrown on the near side, this loop is passed round the neck at its 
base, the knots resting on the external face of the forearm ; the free 
part of the rope is twisted round the forearms to secure the fore legs ; 
it is, afterward, passed from the outside to the inside in\yards round 
the coronet of the left leg, then carried along the right side of the 
ribs towards the posterior parts of the withers. The operator places 
himself on the left side, a little back of the shoulder, holding the 
loose end of the rope, slowly pulling on it, while he slightly strikes 
on the lower part of the left hind leg ; this is soon raised from the 
ground and then carried forward by the traction of the rope. As 



1 8 VETERINARY SURGICAL THERAPEUTICS. 

soon as the animal tries to defend itself, the assistant at the head and 
the operator pull tog-ejher. "The animal slides, so to speak, on the 
body of the operator," and falls without danger. The two hind legs 
are secured with the rest of the rope. 

The Russian method is analogous to that of Rohard. It con- 
sists in raising a hind leg and pulling the head and trunk in the 
direction in which the animal is to fall. If the horse is to be laid on the 
right side, a stout rope is passed round its neck in a loop which has 
a ring, where it rests on the left elbow. Another rope, or a long 
leather strap, secured to the ring, is carried round the near hind leg 
from within outwards, then back to the ring, and is pulled upon 
backwards from the opposite side. (Fig- i6.) The operator, stand- 
ing on the side where the animal is to fall, pulls on the halter or 
bridle with one hand and on the rope with the other, and with mod- 
erate force compels the horse to lie down. 

For donkeys and very small horses the following method is very 
convenient : Take a side line, fix it by one of its ends to a front 
coronet, fasten it to that of the opposite fore leg. With a second side 
line fix both hind legs in the same way. Pass the former side line 
backward between the hind legs, and the other forward between the 
fore legs. When the assistants at the head and at the tail pull on 
them the animal falls. Twist the ropes tightly together, have them 
held by assistants. 

With the Daviau table, aseptic operations can be performed, and its 
use is not accompanied with fractures and muscular lacerations so 
frequent with the other means used for restraint in a recumbent 
position. It consists of a solid wooden table, to which is fastened 
as a covering a thick mattress, and which, by a special mechanism, 
moves from a vertical to a horizontal position. While the table is 
vertical, the animal, with his head covered with a hood, is brought 
near it, and immobilized with straps and hobbled (fig. i8), all 
the cords being secured to wooden pins on the under side of the 
table. When the horse is secured, the crank of the mechanism is put 
in motion and the table brought to the horizontal position and the 
height required for the operation. Generally, with this apparatus, 
animals react but little. When this apparatus was first made, it 
was necessary, in turning the animal over, to relieve it from its first 
position, and then to secure it in the same way on the other side. 
With the improved table, which is mounted upon wheels and which 
can be firmly fastened to the ground, the horse can be turned over 
without changing the horizontal position of the table. 

With the Vifisot apparatus {^g. 6), the horse can also be turned 
over without difficulty. He is fixed as for standing operations, with 
the head secured to one of the upright posts, the sling and the chains 



SECURING OF SOLIPEDS. 



19 



made tight. To the horizontal bar upon which the horse will rest, 
a double cushion is attached to form a table. By action of the great 




Fig. 17.— Tlirowing with two leading-reins. 

crank (d), this apparatus, turning on the axis (a a) as a pivot, situated 
at some distance from the ground, is gradually brought down. It 




Fig. 18. — Daviau's apparatus. 

is easy then to unloose the legs and secure them to the bars orcross~ 
pieces. The operator can thus operate sitting down ; the leg of the 
animal is firmly secured ; there is no dust as with the straw bed ; the 



20 



VETERINARY SURGICAL THERAPEUTICS. 



asepsis is very easy. In raising the animal, the end of the great- 
chain is passed througli the middle eye of the lever, the crank is put 
in motion, and the apparatus, gradually raised, returns to its vertical 
position. The manipulations necessary for changing the position of 
the animal and turning it over require a long time. 

We. have said that the means used for a forced recumbent position, 
no matter how carefully, may be followed by accidents. None is 
positively safe. Still, accidents are less frequent with the perfected 
operating tables than with the straw bed on the ground. 

Several other tables of American invention are also used to take the place 
of the Daviau; among them are those of Hodgson & Nagee, Tiffany, 
Pierce, etc. (T.) 

RESTRAINT OF CATTLE. 

RESTRAINT OF THE STEER STANDING. 

Almost all operations are made with the animal standing. The horns 
and the hind legs must be guarded against. 




Fig. 19. — Contention of a fore-limb. (Hess.) 

I. Securing Ihe head. Is it for a simple operation, — examination: 
of the eye, or of the mouth, for instance, — an assistant, standing on; 
the left side of the animal, holds the left horn with his left hand, 
passes the right between the horns and takes hold of the muzzle, 
which he squeezes, with the thumb in one nostril, the index and 
middle finger in the other. Thus the head can be held firm and raised 
at will. 

Another method is that of fixing at the base of the horns a stout 
rope, successively twisted round the chest and the abdomen, and 
secured to the base of the tail. Thus the animal is prevented from 
lowering its head on account of the pain which it inflicts on itself in 
attempting to do so. 

When the animal is hard to control, the head must be attachedl 



RESTRAINT OF CATTLE. 



21 



ifirmly to a ring-, a tree or a post. Three or four twists of a rope 
passed round the horns and through the ring are generally sufficient. 
The rope may also be rolled round the inferior part of the head. 
Sometimes the animal is placed with another (in the ordinary yoke), 
as in a team. 

2. Securing the fore legs. For raising a fore leg, one proceeds 
as with a horse, using the hand alone, or a rope or strap passed 
round the fore arm or the coronet. 

The animal may also be placed beside a cart, with its head held 
by an assistant or fastened to the cart. A rope, fastened to the 
coronet, is passed over the back of the animal and pulled by an 
assistant on the other side of the cart. (Fig. 19.) 

The LeGoff apparatus is also used to control the movements of the 
ox, as it is those of the horse. 

3. Securing the hind legs. The anatomic disposition of the coxo- 
femoral articulation of cattle does not allow kicking straight out 




Fig. 20. — Hind-limb fastened to a bar. (Guittard.) 



backwards; but kicks from the front and sides are to be feared. To 
guard against them, both legs can be tied together above the hocks 
with one or more turns of a rope, which, held by an assistant, can 
be loosened should the animal struggle much or threaten to fall. 

The tail passed in and out round a leg, and pulled backwards, 
prevents a kick forwards. 

A pole, held by two assistants in front of both hocks, is a means 
frequently used. By resting the pole, one end on the ground and 
"the other on his shoulder, an assistant can push and keep the animal 
against the wall, and prevent it from kicking forward. Also, one 



22 VETERINARY SURGICAL THERAPEUTICS. 

can raise a hind leg from the ground with a rope which is tied to the 
fore arm of the same side, or to the horns. 

It is at times difficult to hold a hind foot backwards. Several 
devices for doing it are recommended : 

A loop of strong cord is passed above the hock, then twisted with 
a stick of wood. This means of restraint, which acts as a twitch, 
gives rise to a sharp pain, by which the movements of the animal 




Fig. 21. — Hind-limb fastened to a bar held by two assistants. (Hess.) 

are kept under control. When the pressure is sufficient, one end of 
the stick is carried in front of the leg to be raised and then back of 




Fig. 22. — Fastening of one fore and one hind limb. (Hess.) 



the one on the opposite side. Two assistants, taking hold of both 
ends of the stick, raise the leg backwards and hold it in place for 
the operator. Should the animal begin to fall, the leg can be readily 
let loose. 



RESTRAINT OF CATTLE. 



23 



Put the animal in a yoke with its mate, alongside a truck or a cart, 
in such a manner that the leg to be raised is on the outside ; tie both 
animals to a tree, a strong post, or a ring. Tie a rope in a running 
knot above the hock of the leg to be raised, and another in the fold 
of the coronet ; an assistant pulls the rope backwards and winds it 
round the hub of the corresponding wheel of the cart. Another 
assistant holds the leg up with a wooden bar put in front of the hock 
and resting at one end on the shaft of the cart. 

A simpler method is to use either the rope or the wooden bar alone. 

The method of fastening shown in fig. 20 is also a very good way 

to fix a hind leg. 

Another way is to place the animal against the cart, with its head 
held by an assistant or secured to the vehicle, its body free or 
fastened with a rope held by an assistant. The leg which is to be 
raised is secured at the hock with a wooden bar, one end of which 
is placed between the spokes of the wheel, above the hub, the other 
held by assistants (fig. 21). If the animal is very restless, or ugly, it 
can be controlled better by raising the forward leg opposite the one 
behind which is to be operated upon. A rope fixed round the coronet 
is then held by an assistant as in fig. 22. 

Stocks which are used for horses can also be employed for cattle, 
a yoke being placed on their head to steady it. A special, narrow 
stock has been invented by Goiffon, with which the animal is more 
easily kept quiet. 

Restraint of Cattle in a Recumbent Position. 

In using small hobbles, which are placed on the coronet or the 
fetlock, the modus operandi is the same as for horses. A thick 




Fig. 23. Throwing of an ox. (Rueff.) 



24 



VETERINARY SURGICAL THERAREUTICS. 



mattress of straw is to be prepared to prevent fractures of the 
horns. 

To throw an animal with hobbles, two side lines may be used. 
With one, both fore legs are brought together as close as possible ; 
with the other the hind legs are treated in the same way. The free 
ends of both side lines are then passed crossing each other, between 
the extremities, that of the fore legs backward and that of the hind 
legs forward. Traction on both ropes in different directions, also 
on the head of the animal towards the side upon which he is to fall, 
with a push at his hip, will make him fall down. The ropes are 
then secured by knots. 

The method of Rueff sometimes answers very well. A long rope 
is tied round the horns in a loop at one end, then carried along the 





Fig. 24. — Snuffer-nippers. .(4, screw nippers.— 5, sliding-tongs. 

dorsal border of the neck to its posterior third, where it is twisted 
once round the neck, passed back to the withers, where back of the 





Fig. 25. Nasal ring. — A , open ring. — B, shut ring. 



shoulders another twist is taken, and again in the same way an- 
other back at the flank. The end of the rope is then held and 



RESTRAINT OF SMALL ANIMALS. 



25 



pulled by an assistant, who, as he passes it along- the sacrum to 

the le/l or the right, forces the animal to lie down to the left or to 

the right (fig-. 23). 

Cattle are dangerous, especially bulls; but they are readily controlled 

by nasal pincers or rings. These instruments are common, and 

extensively used. 

The stick which is used to drive the animal is made in various 
shapes, straight or in the form of an S, as that of 
Roland. The Vigan apparatus is very powerful and 
permits perfect control of the most vicious animals. 

RESTRAINT OF SMALL ANOIALS. 

Sheep are easily held in any position. For castra- 
tion, the sheep is held sitting down on its haunches, 
the abdomen towards the surgeon, between the 
limbs of the assistant, who holds in each hand the 
two legs of one side. In order to carry the sheep, the 
two legs on both sides are first tied together and then 
secured by two or three turns of rope. 

The pig is generally taken hold of by one hind leg 
above the hock. When the animal is to be cast, 
another assistant is required, who takes hold of his 
ear. If the mouth or the throat is to be examined, a 
speculum is necessary, or the mouth must be kept 
open with a stick — the handle of a twitch. 

Opposite traction with ropes on both jaws may 
give the same result — especially if assisted by the 
speculum. 

For the dog, in all painful interferences, a muzzle 
or a band wound round the jaw^s and fastened behind the ears, is 
to be used. Important operations ought to be performed on a table. 
Dangerous dogs and those suspected of madness are held with long 
nippers, the curved jaws of which grasp the neck. 

For castration and other operations performed on cats, the animal 
is held by the assistant, taking it by the skin of the neck in one 
hand and that of the loins in the other, and keeping it flat on the 
table by gentle pressure. The cat may also be placed in a narrow 
sack, in the leg of a boot, or partially wrapped up in a blanket. 

Besides the wounds of the skin, and the bruises of subcutaneous 
structures, one may observe as accidents which are liable to follow 
castings : muscular, tejidi?wus, or aponeurotic laceratiojis ; lesions of 
large blood vessels and nerves and their consequent paralysis ; 
fractures; and luxations. A strict ol)servance of the rules for restraint 
and casting may prevent most of these accidents, but there are some 



Fig 26. — Leading 
stick. (Roland.) 



26 VETERINARY SURGICAL THERAPEUTICS. 

which will take place in spite of the greatest care and attention. 
The therapeutics of these will be studied in special chapters. 



II. 

GENERAL ANESTHESIA. 

The idea of relieving pain is as old as the art of healing. In all 
ages, surgeons have occupied themselves with the idea of diminish- 
ing suffering during an operation. 

For a long time their attempts failed ; and it is scarcely fifty years 
since hope of ever succeeding was almost given up. "To avoid 
giving pain in operation," said Velpeau, " is a dream that cannot be 
realized : sharp instrument and pain are, in operative medicine, 
words that do not present themselves one without the other ; their 
union must necessarily be admitted." A few years later the dream 
was a reality. On the 14th of October, 1846, Warren performed 
before the students of the Medical College in Boston the first opera- 
tion with anaesthetics. After putting a patient under the influence 
of ether, administered by Morton, he removed without the least 
evidence of sensibility, a tumor of the neck, which required a long 
and delicate operation. When the patient awoke he declared he 
had felt no pain. Such was the first important application of the 
discovery of Morton. It opened the era of Surgical Anaesthesia. 
(Forgue & Reclus.) 

A month later, anaesthesia was known in Europe. Boots and Lis- 
ter first employed it in England. On the 12th of January, 1847, 
Malgaigne related to the Academy of Medicine several operations 
which he had performed without the slightest pain to his patients. 
Facts, favorable to the method, soon were coming from all direc- 
tions. During the year 1847, veterinarians experimented on ani- 
mals. Renault, Bouley, Thiernesse, and Rey published the first 
observations showing the advantages that etherization give in serious 
operations performed on the horse. 

At first ether was used exclusively. Objections were made to it on 
account of its great volatility, inflammability, and its strong odor, 
which incommoded the surgeon or his assistants. To palliate these 
inconveniences a special apparatus of inhalation had to be used. 
On the loth of November, 1847, Simpson made known the anaes- 
thetic properties of chloroform ; resting on the results of fifty opera- 
tions, he declared it superior to ether. From comparative trials 
made with the two products, chloroform won ; and it is chloroform 
that has generally been used up to the present time by humane sur- 
geons. Ether, however, always has its supporters and its own uses. 
If chloroform is less volatile, less objectionable in odor, and less 



GENERAL ANHvSTHESIA. 27 

combustible, if its action is quicker and more powerful, it is also 
more dangerous than ether. The latter brings on more slowly a 
sleep which is not so deep, it gives rise to a state of excitement more 
marked ; but well administered it is almost always harmless. 

In later years, other substances and other processes have been 
recommended, to obtain narcosis in various domestic animals as 
subjects. A mixture of ether and chloroform, administration of 
ether by way of the rectum, of morphine, with chloral injected 
into the veins, rectum or peritoneum, or of chloroform with mor- 
phine and atropine, benzine, hypnone, urethane, paraldehyde, 
bichloride of methylene or amylene, have been recommended. For 
cattle, only alcoholic liquors in large doses can be used, as other- 
wise, in cases of accident from the operation, the meat could not be 
used by the butcher. 

\n gC7ieral ancEsihesta, the patient is put into a more or less deep 
sleep. But it is not always necessary to act upon the whole physi- 
cal system ; on the contrary, one may numb only a given part of 
the body upon which the operation is to be performed. For local 
ancEsthesia the principal agents are : cold (snow, ice, cooling mix- 
tures, or the nebulizing of some liquids), cocaine, stenocarpine, spar- 
teine. 

The use of anaesthetics is more limited in the case of animals than 
hi the case of men. No doubt we ought to endeavor to spare our 
patients pain ; but, generally, our interference must be with as little 
cost as possible ; and also narcosis has its dangers. With means of 
restraint at our command, we can perform almost all operations 
without having recourse to the use of anaesthesia. This is useful, 
however, in some cases, to diminish or prevent struggles and sud- 
den movements of the animal at the time of the operation. The 
struggles and motions of the animal at times render impossible the 
performance of some manipulations (reduction of hernias, distocial 
labors) ; at other times they may give rise to serious accidents when 
the hand alone or holding in it a sharp instrument moves about in a 
region, delicate on account of its anatomical disposition, as in intra- 
abdominal operations. Anaesthesia is also useful in delicate opera- 
tions upon the eye or its surroundings, and in all serious operations 
upon well bred animals, whose struggles are peculiarly violent. 
Moller recommends it for castration of horses whose backs are short 
and powerful in muscles. With ruminants anaesthesia is generally 
used only in difficult labors. In carnivora, especially dogs, the 
principal uses are in laparotomy, distocial deliveries, amputations, 
and some operations on the head. 

Among the principal cases to be noted which do not admit of the 
ViSQ o{ getieral ancBsthesia must be mentioned : ist. Diseases 0/ the 
heart (valvular diseases or myocarditis, dilatation, hypertrophy). 



28 VETERINARY SURGICAL THERAPEUTICS. 

2d, Diseases of the respiratory organs (emphysema, chronic pneu- 
monia, and pleurisy). These affections predispose to rapid and to 
slow syncope. Ether seems to be the chosen anaesthetic for animals 
suffering- from emphysema or from dilatation of the right side of the 
heart ; chloroform does better for affections of the left side of the 
heart ; chloral is the most advantageous when there are intermittent 
effects. (Arloing. ) 

For bloody operations upon the face (sinuses and nasal cavities) 
if anaesthesia is used, the head must be secured so as to assist the 
fiow of the blood outwards ; one must prevent its running- into the 
respiratory tract, where it will give rise to suffocation. 

Narcosis being the result of the special action produced directly 
iipon the nervous centers by that which gives rise to it, there is one 
indispensable condition to its realization, viz., the reception on these 
•centers of a sufficient quantity of the anaesthetic used. 

While some fixed anaesthetics rnay be administered through various 
agencies (veins, mucous or serous membranes or subcutaneous 
cellular tissue), volatile anaesthetics, to produce all their effects, 
must enter by the respiratory mucous membrane. Injected into the 
organs or into the veins, the former run through the pulmonary 
capillaries without sensible loss and act in mass upon the centers ; 
the others escape, in great proportion, through the walls of these 
blood-vessels, and what remains in the arterialized blood is not 
sufficient to produce anaesthesia. On the contrary, if these volatile 
agents are introduced in the shape of vapor into the respiratory 
tract, they penetrate, in great part, into the blood which goes down 
to the left side of the heart, and this quantity, thrown intact into the 
arterial tree, rapidly produces anaesthesia, which soon becomes 
complete. 

I'hus directly carried in the respiratory tract, anaesthesia gives rise 
to a series of phenomena, following one another in regular order. 
The progress of anaesthesia may be divided into three periods : 

1st, l^\\'a.\. ol excitement \ 2d, WvaXoi ancBsthesia, ancestlietic tolera?ice, 
or the surgical period ; 3d, that of collapse or intoxicatio?i. 

The first, or period oiexcitemeni, due to the action of the anaesthetic 
vapors upon the ends of the nerves of the mucous membrane of the 
superior respiratory organs (nasal cavities, larynx), and again, to 
the action of those vapors upon the nervous centers themselves, is 
■characterized by disturbance of the sensibilities, by restlessness, 
and by the hyperaethesia of the organs of sense. Violent reactions 
take place, the respiration and circulation are accelerated, the mucous 
membranes congested, the pupil dilated ; but soon the heart becomes 
slower in its movements ; the respiration more regular, easier and 
slower ; the pupils contract, the restlessness subsides, sleep begins. 
During this first period, anaesthetic vapors may give rise, in those so 



GENERAL ANESTHESIA. 



29 



predisposed, to respiralory syncope, cardial syncope or asphyxia 
by spasm of the gloilis. 

The period of a//c^s///es/rt is characterized by arrest in the activity 
of the nervous centers, cerebral lobes, spinal cord and mesoceph- 
alon. The patient is in an artificial sleep. The excito-inotor 
centers are paralyzed, the muscles in a state of relaxation ; the legs, 
when raised, fall inert upon the ground. Respiration is slow, the 
movements of the ribs are limited, those of the flank more expanded 
than ordinarily. The heart becomes accelerated as soon as its 
moderating center is paralyzed, but the pulse remains regular and 
full untd the stage of intoxication is reached. The eyes stare, the 
pupils remain contracted and immobile. As sensibility passes from 
the various organs, reflexes cease to take place in them. 

The disappearance of sensibility does not take place simultaneously 
in all the tissues nor in all regions ; it successively progresses to the 
organs of spinal sensibility — the legs and trunk — to the organs of 
sense, to those under the influence of nerves rising from the bulb, and 
at last to those controlled by the great sympathetic nerve system. 
It is on the nasal, buccal, ocular mucous membranes and towards 
the genital organs that the last reflexes are observed. At times, 
when anaesthesia seems complete, the first cut of the bistoury 
given in a diseased region, inay give rise to a reaction ; this is due 
to the fact that some altered tissues, very sore, remain still the seat 
of a peculiar sensibility, while all the other tissues round them are 
asleep. When the interference is to take place upon inflamed 
parts, the operative zone may then remain the '■'idti^ninn dormicns," 
the last to lose its sensibility under the action of the anaesthetic. 
As soon as the narcosis is complete, all that is necessary to keep 
it up is to continue the administration, in small doses, of the 
agent used ; with large doses, anaesthesia will soon pass to the third 
period. 

Produced by the absorption of too large a quantity of anaesthetic 
vapors, the period oi collapse or intoxication has for principal signs : 
the more and more marked slowness of respiration and of circula- 
tion and the sudden dilatation of the pupils ; respiratory movements 
are limited and stop at intervals ; the cardiac systoles are reduced, 
the pulse is small, soft and irregular. Finally the bulb, "ullinmrn 
moricjis," is intoxicated, respiration stops, the heart ceases beating. 
Death takes place by respiratory syncope. 

Whether ether, chloroform, or other agents are used, the 
phenomena of anaesthesia present several peculiarities which ought 
to be known. With ether, we have said, the period of excitenient 
is more marked and lasts longer than with chloroform. With some 
fixed anaesthetics, the period of excitement is suppressed or scarcely 
marked. If the mode of the special action of chloral is yet to be 



30 VETERINARY SURGICAL THERAPEUTICS. 

discussed, every one knows that this agent injected into the veins, 
produces immediately a deep ancesthesia, without a period of ex- 
citement. On the contrary, morphine salts give rise at times to a 
strong excitation which lasts several hours. But these differences 
observed in the progress of anaesthesia, produced by ether, chloro- 
form, or chloral, are more interesting to the physiologist than to 
the practitioner. What interests him is the degree of toxicity of these 
agents, and the dangers that they present to the patient. And of all 
general anaesthetics there is no one which is free from danger. Even 
in veterinary surgery, where their use is yet so limited, they all have 
several records of death laid to their account. 

ANAESTHESIA OF THE HORSE. 

ANESTHESIA WITH ETHER. 

This is the anesthetic mostly used in France for horses. It is 
administered with a sponge, with a ball of oakum, or with a com- 
press. In giving the ether in progressive doses, if necessary, sus- 
pend the inhalations at given times ; stop them or considerably 
reduce the dose as soon as anaesthesia is obtained ; especially during 
the time that it lasts, watch the respiration and the reflexes. Such 
are the principal rules to follow. 

The patient, with an empty stomach, is cast, having been relieved 
of everything that might interfere with respiration, or press on the 
throat, the lower border of the neck, or the thorax. 

It is preferable to use a compress twenty centimeters square, which 
is thrown over the nostrils. An assistant pours, in small quantities, 
the ether on the compress, which is kept more or less close to 
the nose, as the anaesthetic is to be allowed to penetrate with greater 
or less force. 

The mucus of the superior respiratory organs becomes intolerable ; 
for this reason, the first vapors of ether give rise to more or less 
excitement, the horse whinnies, struggles sometimes violently, the 
respiration and the circulation become accelerated. These phenomena 
last sometimes from ten to twenty minutes. In the first stage of anaes- 
thesia a whirling round of the eyes is observed. Upon some horses 
the eyelids close and open after narcosis is completed. After the 
period of excitement is passed, if respiratory or circulatory troubles 
manifest themselves, if the respiration becomes accelerated or now 
and then partly suspended, if the pulsations are small, increased, 
irregular, or intermittent, the inhalations must be suspended at once. 

The disappearance of sensibility, the muscular inertia, the char- 
acter of the pulse and of the respiration, the changes of the pupil, 
the persistency or the arrest of the palpebral reflex, permit one to 
recognize the extent of the anaesthesic sleep. Complete narcosis is 



AN/ESTIIESIA OF THE HORSE. 3 1 

especially characterized by the disappearance of conjunctival reflex 
and atresia of the pupil. When anaesthesia is carried to that ex- 
tent the touching of the conjunctiva and of the cornea no longer 
stimulates the action ot the orbicular palpebral — the last reflex of 
animal vitality. For this reason it is considered by all surgeons as 
the true regulator of anaesthesia. When it has ceased to be present 
and as lonsr as it remains absent the inhalations must be suspended, 
to be renewed again as soon as it reappears.. This sign is of the 
greatest value, for it characterizes complete ancesthesia, and the mo- 
ment it appears the case is known to be yet far from the period of 
toxic accidents. The variations of the pupil give also useful indi- 
cations. As anaesthesia progresses, the pupil, which had dilated 
(mydriasis) in the period of excitement, contracts (myosis) ; it re- 
mains narrow and immovable as long as the sleep lasts, and slowly 
dilates again as sensibility returns. Its sudden dilation during an 
advanced stage of anaesthesia is a sign of bulbar intoxication, and 
threatens syncope. 

When palpebral reflex has ceased and the pupil is contracted, sen- 
sibility has disappeared and m.uscular relaxation is complete. If res- 
spiration and circulation take place in a regular way, anaesthesia may 
be continued for a long time without danger, by adding now and 
then new doses of ether. 

The operation ended, the hobbles are removed from the patient, 
he is left to himself until he wakes and gets up. 

In order to avoid the waste of ether, which is very volatile, the 
apparatus of Junker, used by some to administer chloroform, has been 
recommended. In its simplest form this apparatus consists of a 
graduated glass containing the anaesthetic, and closed with a cork 
perforated with two holes, through which are introduced two bent 
glass tubes. One of these, dipping in the liquid, carries on the other 
end a Richardson bellows (s) ; the other tube, which is shorter and 
does not reach the liquid, carries at the other end a pear-shaped ball 
(r), which is introduced into the nostril. (Fig. 27.) As soon as the 
Richardson bellows is squeezed, air is pushed into the liquid and 
loaded with anaesthetic vapors and bubbles, and is carried to the 
respiratory organs, without waste, through the other tube. Narcosis, 
however, is quite difficult to obtain with this apparatus, even in 
using one for each nostril. To make the instrument more portable, 
the glass tubes have been replaced by metallic ones, and the gradu- 
ated glass has been provided with a metallic hook, to hook it to the 
button holes of the assistant who administers the anaesthetic. In- 
halers with valves were discarded long ago. Leather muzzles, 
metallic masks, sacciform inhalers, are less in use than compresses. 

Often to produce sleep a large quantity of ether must be adminis- 
tered — 250 to 500 grams, and even more. The waking up with ether 



32 



VETERINARY SURGICAL THERAPEUTICS. 



is also slower than with chloroform. The animal remains stultified 
for a longer time. These disadvantages are compensated by a smaller 
liability to injurious effects. 

Althoueh less dansrerous than chloroform, ether is not harmless, as 
pretended by some. In human surgery, though less used than chlo- 
roform, it counts numerous fatal cases. If Oilier, out of 40,000 anaes- 
thetic operations at the Hotel Dieu, of Lyons, has not oije single 
death to record, it is because of his "happy luck'' {serie heureuse). 




Fig. 27. — Inhaler for etherization or chloroforming. 

In Lyons itself, from 1857 to 1878, there have been six deaths due to 
ether. (Vallas. )' The statistics of Giirlt, which we shall consider 
later, show that, with ether, cases of death have been fifteen times 
less numerous than with chloroform. 

Anaesthesia, by introduction of vapors of ether into the rectum, 
tried first on animals (Dupuy, Thiernesse), was highly recommended 
for man by Pirogoff (1847), and recently by Daniel Molliere (1884). 
It has been recommended by Cagny for horses, especially to produce 
in them a certain degree of sleepiness so as to diminish some of the 
dangers of casting, or permit the execution of simple operations in 
the standing position. The niodtis operandi \s simple. A bottle full 
of ether has on its mouth an India rubber tube which is introduced 
into the rectum. The bottle is put into a water bath at 50°. The 
evaporation begins at once ; the vapor enters the rectum and is ab- 
sorbed by the mucus. Thirty to fifty grammes of ether are sufficient. 
Experiments have failed to confirm the advantages claimed for this 
method. Often, instead of the semi-anaesthesia which one intends 

(') Lepine, Semaine Medicale, 1S78, p. 301. 



ANESTHESIA OF THE HORSE. 33 

to produce, violent reactions take place, and powerful expulsive 
efforts may bring- on prolapsus recti. In man, some cases have been 
seen complicated with cyanosis, collapse and true asphyxia. 

This treatment is so uncertain in its effects and has such serious 
inconveniences and even dangers, without any real advantage, that 
it has never found favor or been adopted. 

Anaesthesia produced from a combination of vapors of ether in the 
rectum, and morphine and chloral, is slow in its effects and not prac- 
tical. 



AX.i;STHESIA BY CHLOROFORM. 

When one wishes to obtain a rapid and complete anaesthesia in a 
horse he must use chloroform. It is not so dangerous for solipeds 
as it is claimed to be. IMoller, who employs it exclusively, has 
anaesthetized hundreds of horses without a single accident. He has 
produced narcosis in horses with chloroform and made numerous 
experiments, of which he gave an account in the first volume of the 
Monaischifie fi'ir prakiisclie lliierheilkiaide. 

In those experiments, INIoller has inquired into the practical value 
of the method, the dangers to which those operated upon are ex- 
posed, the time required to produce the narcosis, its duration, and 
the quantity of anaesthetic required. He has studied the influences 
that, from these various points of view, the weight, the breed, and 
the age and sex of animals might have. 

Comparing the results obtained in a list at first of 126 horses (31 
stallions, 38 mares, and 57 geldings), all of which were anaesthetized 
until arrest of ocular reflex, he finds that the average quantity of 
chloroform used is no grammes for each subject, about 25 grammes 
for every 100 kilogrammes of the weight; that the time required to 
produce narcosis has been in average 20 minutes ; and that its dura- 
tion has been also 20 minutes. In colts i and 2 years old, anaes- 
thesia was obtained in 7 to 8 minutes with 15 to 20 grammes of 
chloroform. It was complete in 7 minutes, using 35 grammes of 
liquid, with one 4-year-old horse, with 3 others in 8, 9, and 10 min- 
utes. With 12 animals it was not complete until after 30 minutes ; 
with 4 it required 35 to 40 minutes. It required 18 minutes on the 
average for stallions, 19 for mares, 22 for geldings. While 7 horses 
were anaesthetized, using 50 grammes, with 18 (5 males, 4 mares, 9 
geldings) it took 150 grammes; an adult mare required 240, and a 
thoroughbred stallion received 250. 

In 28 horses which received 50 centigrammes of morphine in hypo- 
dermic injections half an hour before the administration of the chlo- 
roform, anaesthesia was obtained, in average figures, after 15 min- 
utes with 93 grammes. For 8 horses, ether and chloroform were 
3 



34 VETERINARY SURGICAL THERAPEUTICS. 

mixed together. This mixture required 210 grammes and half an 
hour to produce sleep. No noticeable difference could be observed 
by using chloroform of various productions. 

Most of the animals which received morphine and chloroform ex- 
hibited manifestations of greater excitement than with chloroform 
alone or mixed with ether. Like Moller, Harms recommends chlo- 
roform for anaesthesia of horses ; he kept, with 128 grammes, during 
two hours, a large horse in a complete state of muscular resolution. 

While chloroform, well prepared and preserved, and thoroughly 
pure, rapidly produces sleep, if it is impure or loaded with chlorine, 
anaesthesia is slower, less complete, and full of starts ; and syncope 
is to be feared. To avoid alteration of the chloroform, a small quan- 
tity of ether should be added to it, and it should be kept in blue or 
yellow glass corked bottles, in a dark place. 

Chloroform is administered, as ether is, with a sponge, a ball of 
oakum, or a compress. A method rapid or powerful in its action is 
dangerous and should be rejected. A slow and easy method, which 
consists in allowing the entrance of a mixture of air and vapor 
of chloroform, is the only one to be recommended. The assistant 
must pour the anaesthetic very slowly, drop by drop (2 or 3 in each 
second). From time to time the nostrils and the pituitary mem- 
brane are wiped off with a cloth or some wadding to prevent the 
irritating effect of the chloroform. With the same object vaseline 
can be applied on the nose. Several authors (Roux, Gresswell, 
Fohringer, Zangger, Hirzel) have recommended the use of special 
apparatus ; but most of it is dangerous, since it prevents the entrance 
of the air. It is not necessary to suspend the inhalations from time 
to time, if the chloroform is poured out drop by drop. 

The period of excitement lasts only a few minutes; in some sub- 
jects it is scarcely observed. Soon the animal goes to sleep, into 
a much deeper one than with ether. By repeating the inhalations 
anaesthesia can be prolonged for an hour, an hour and a half, or two 
hours, without any dangerous appearances. 

When there is a cessation of the chloroform-giving after it has 
been administered for a long time, temporary arrests in the respira- 
tion may be manifest. Moller has seen them lasting 30, 40 and 45 
seconds. Slapping of the lips and the cheeks with the hand or a 
wet cloth is sufficient to stimulate reflexes and the return of respira- 
tion. Some subjects seem to possess a peculiar sensitiveness to 
chloroform ; with them, the first vapor gives rises to great excitement 
and the progress of anaesthesia is somewat singular. A few fatal 
cases have been recorded, many others have not been ; but, with 
few and very rare exceptions, pure chloroform does not "kill" 
except when badly administered, or given to animals having cardiac 
or pulmonary affections. At the posi-r}iorte?n examination of a horse 



ANAESTHESIA OF THE HORSE. 35 

that had died during- the administration of chloroform, Kemp ' found 
-an enormous hypertrophy of the heart and a valvular endocarditis 
Avith aneurism of the aortic sigmoid valves. Following' chloro- 
formic narcosis, inflammatory lesions of the pituitary membrane 
and of the mucous membrane of the sinuses and also pneumonia 
have been observed. (Jacobi, Ries.) 

In man, cases of death during anaesthesia by chloroform are rare, 
none having ever been observed by the surgeons who daily perform 
many operations in the hospitals. Konig has given it to 7000 
patients and Nussbaum to 15,000 without a single accident. When 
Billroth lost his first patient, he had already used it without harm in 
12,500 cases. General statistics from German surgeons, however, 
show more serious losses : 99 deaths out of 285,380 persons put to 
sleep, or i for every 2,880. At the last German Congress of Surgery, 
Gurlt reported from 163,490 cases 61 deaths, an average of i in 
2,680. From 32,725 chloroform cases, there were 17 deaths, i for 
1,924 ; when a mixture of ether and chloroform was used, the 
mortality was i in 8,014; when ether, i in 26,268.^ Lepine says 
that, taking into consideration the number of accidents unpublished, 
"it can be assumed that there is at least one case of death out of 
1,200 where chloroform is used." ^ On that amount Korte, Landau, 
Vogel,4 Poncet, Augagneur, Gangolphe s have tried to have the use 
of ether prevail. 

Graded mixtures of air and chloroform (method of Clover and 
P. Bert), recently recommended by Dubois, require the use of special 
apparatus, which is not used for animals. 

The Comhiiiation MelJiod — inhalations of chloroform after injection 
of morphine and atropine — recommended for dogs by Dastre and 
IMorat, can be used for anaesthesia of solipeds. To a horse of middle 
size an injection of 10 or 15 centigrammes of muriate of morphine 
and 5 milligrammes of sulphate of atropine, in a solution of 10 
grammes of distilled water, is given. Half an hour after the injec- 
tion, the animal is thrown and the administration of chloroform 
begins ; anaesthesia takes place rapidly. In the experiments that we 
have made with Desoubry, it was obtained in about 7 minutes. 
The average dose of chloroform required was about 65 grammes. 
The same substance administered alone would not produce narcosis 
in less than 15 minutes; the average quantity required would be 
120 grammes. Non-appearance or diminution of the period of ex'» 
citement, and the certainty of avoiding cardiac syncope, are the 
principal advantages of this method. 

1 Kemp, A merican Veter. Eevieiu, 1883, p 498. 

^ Gurlt, Deutsche ined. Zeiiung, 1894, Berlin. Thierarztl. IVochenschr., 1894, p. 357. 

' Lepine. Semaine Medicale, 1S94, p. 301. 

' Korte. Landau, Vogel, Ibid., 1894, p. 62, iii, 126. 

^ Poncet, Augagneur, Gangolphe, Mercredi midical, 1894, p. 211, 225, 247. 



36 VETERINARY SURGICAL THERAPEUTICS. 



ANAESTHESIA WITH CHLORAL. 

As an anaesthetic for the horse, chloral is used alone, in intravenous; 
injections or associated with hypodermic injections of morphine and 
administered in rectal enemas. 

Intravenous Injections. — Investigations of Ore and of Vulpian 
have shown that a i — 3 or i — 5 solution of chloral injected in the 
venous apparatus, produces a very rapid complete anaesthesia. This 
method, declared dangerous by Colin, which surgeons for mankind 
(Gosselin, Trelat, Lefort) have immediately condemned, has been 
recommended in France and in Denmark for the horse, on which an 
intravenous injection is easily made at the jugular. 

This method, studied in 1875 by Humbert, who succeeded in the 
case of a great number of animals, without an accident, and rec- 
ommended by him in 1884, is excellent for producing a deep 
narcosis in horses used for experiments or for the practical services- 
of surgery (Nocard). The apparatus of Dieulafoy is used with a 
filtered solution of i — 10, i — 15 or i — 3, which is injected into the 
jugular in variable quantities, according to the subject. When fresh, 
the solution is neutral ; if it becomes acid, a small quantity of car- 
bonate of soda should be added to it. 

When an intravenous injection is applied for a therapeutic pur- 
pose, it requires a somewhat delicate management. The rules of 
antisepsis — disinfection of the region, asepsis of the trocar or of the 
needle — must be strictly observed. When everything is prepared, 
an assistant presses the vein at the lower end of the jugular groove, 
the operator stretches the skin towards the head with one of his- 
hands and with the other pushes firmly into the dilated blood-ves- 
sel, a hollow needle, or a fine trocar, held very obliquely downwards 
and backwards. Humbert advises the introducing of the needle by 
two steps : he perforates the skin first, dilates the vein, and then runs 
through into it ; when the operation is done with the animal stand- 
ing he prefers the right jugular to operate upon. The escape of" 
blood through the canula, after the trocar is withdrawn, indicates- 
that it has penetrated into the vein. An assistant then holds the 
canula in position. The operator at this moment connects the 
mouth of the canula with an India-rubber tube, fitted to the syringe 
holding the fluid, and slowly pushes into the vein the quantity which 
is to be injected. This done, the tube is removed, a little blood 
escaping washes out the cavity of the canula, which is then retracted 
suddenly without raising the skin. Colin indicates as an anaes- 
thetic dose 20 or 30 grammes of chloral ; Arloing, 25 to 50 grammes, 
Nocard, 10 grammes for every 100 kilogrammes of the weight of the- 
animal. Anaesthesia follows almost immediately ; it is more or less, 
profound, and varies in duration according to the chloral injected. 



AN/ESTHESIA OF THE HORSE. 3/ 

In a few moments the animal sleeps, the immobility is complete, the 
muscular relaxation perfect, the mucous membranes have a slight 
'Cyanotic tinge, the respiration and circulation, disturbed for a mo- 
ment, return to their normal rhythm. The wakening is slow ; the 
subject remains stupefied for some time, and in some instances is 
-seized with a general trembling. After a lapse of time, varying from 
half an hour to two hours, the animal gets up staggering, very weak 
m the hind quarters ; comatose manifestations may last for one or 
two hours after. 

When the dose injected has been too large, or the subject is very 
^susceptible to chloral, the sleep is very deep, the mucous membranes 
become darker and darker, the pupil is dilated, respiration and cir- 
culation become slow, the temperature lowers, and death may 
follow. 

If the operation has not been done antiseptically, if the vein has 
been run through and through, or torn during the operation, and if 
by any chance some chloral has escaped in the perivenous tissue, it 
is rare good luck if serious accidents do not follow. Almost all the 
veterinarians who have tried this method have seen complications of 
phlebitis produced, and so have given it up. Phlebitis appears gen- 
•erally from the second to the fourth day ; it is manifested by a swell- 
ing of the jugular groove — a swelling which, sometimes limited and 
^sometimes diffused, ends in suppuration ; frequently, there are ne- 
crotic lesions. In one case we .have seen the vein destroyed and 
sloughed away throughout almost the whole extent of the neck. 
The vaso-dilating action of the chloral has also been objected to, as 
it increases hemorrhage in bloody operations. Though it has been 
but little used, chloral, like other anaesthetics, has its list of fatali- 
ties. Moller has killed several horses by injecting chloral into their 
jugular in doses of 50 grammes. Doubtless one may say that this 
was too large a dose, as long as the weight of the animals was not 
known. In 1889, one of our confreres asked us to assist in firing one 
•of his horses. The animal being very nervous, it was agreed to give 
it chloral by means of an intravenous injection. The dose used 
was not above 10 grammes for each 100 kilogrammes of its vveight. 
During the first part of the operation the horse had some slight re- 
•actions. After fifteen or twenty minutes, when the operation was 
-almost finished, respiration stopped, and a few moments later, not- 
-withstanding the methodical pressure applied upon the thorax to 
guard against asphyxia, the animal died. 

If intravenous injections, performed aseptically by experienced 
hands, is declared harmless, it has unfortunately given to many prac- 
-titioners such results that they had to give it up. " In the case of 
man," says Dujardin-Beaumetz, "the serious accidents which have 
-occurred have forced this procedure to be abandoned." ' Peuch de- 

I. T)v:ATiDi>;-V>E\UMETZ.—L'iirideyor»!7t/er,/>. 41. 



38 VETERINARY SURGICAL THERAPEUTICS. 

dares that it will remain " a procedure confined to the laboratory : " 
Trasbot and Moller condemn it ; and for ourselves, we have wholly 
restricted its use to patients used in our surgical experiments. 

Chlo7'al and Morphine. — To diminish accidents resulting from the 
intravenous injection of chloral, Cadeac and Mallet have proposed 
to bring about anaesthesia by associating it with morphine. Accord- 
ing to their experiments, complete anaesthesia is brought about by 
injecting into the subcutaneous conjunctive tissue a solution of So 
centigrammes to i gramme of muriate of morphine, followed in lo 
minutes by a rectal injection of Soto loo grammes of chloral. 

Narcosis is not always readily brought about. It takes place 
slowly, and is at times preceded by a somewhat long period of ex- 
citement. Esser advises this means in cases in which the use of 
chloroform is prohibited. 

Inhalation of the vapors of chloral does not produce anaesthesia, 
or even sleep. Subcutaneous injections of chloral in aqueous solu- 
tion give rise to diffused gangrenous abscesses with abundant sup- 
puration. Administered in sufficient doses (40 to 50 grammes per 
mouthful), in weak solution, chloral gives rise to numbness, drowsi- 
ness, and inco-ordination of movements, but no -complete anaesthe- 
sia. This process may, however, be used advantageously in ordi- 
nary practice. (Harms.) 

ANAESTHESIA WITH JIORPHINE. 

For horses, subcutaneous injections of muriate of morphine have 
been recommended to produce drowsiness or a slight anaesthesia 
which will permit the performance of some operations upon ani- 
mals standing up. According to size, 20 to 50 centigrammes- 
are injected. The doses of one, one and one-half and two grammes 
(Giirlt) are useless. In some animals, morphine brings on drowsi- 
ness, numbness and a muscular relaxation more or less marked ; 
some animals which are nervous, restless, or dangerous, thus 
become quiet and easy to handle ; but with others, the object is 
not reached even with large doses, and phenomena of excitement, 
which may last several hours, will occur. The patients are very- 
restless, give themselves to violent struggles, rear, shake their heads, 
push them against the wall as in indigestion complicated with brain 
troubles. We have seen these manifestations last for several hours. 
Many practitioners have observed similar cases. This process is- 
then uncertain in its results, but may be of some benefit ; and when 
the dose is small, is perfectly harmless. 

The bichloride of methylene, experimented with by Nigotin in- 
anaesthesia of the horse, has proved inferior to chloroform, as were 



ANESTHESIA OF RUMINANTS AND SWINE. 39 

hypnone, urethane, paraldehyde and benzine. Inhalations of the last 
agent had brought on a state of excitement, followed by drowsi- 
ness after about lO minutes and afterwards a quiet sleep, which 
might be continued by renewed inhalations (Harms). 

ANAESTHESIA OF RUMINANTS AND SWINE. 

On these animals, few operations are performed with anaesthesia. 

The experiments of Tabourin and Saunier have shown that ether 
and chloroform may be administered to the large ruminants without 
running any greater risks than with other animals. Nigotin thinks 
ether dangerous for cattle and recommends chloral (50 to 75 grammes) 
given per mouthful. Harms suggests the inhalation of benzine. 
But for animals which are to be butchered, when a certain degree of 
anaesthesia is to be obtained for surgical purposes alcoholic prepara- 
tions are preferable. For small bovines, the best way is to give them 
a large dose of brandy or of rum (one-half to one litre). After five 
or ten minutes, numbness begins, and by degrees becomes more 
accentuated. Intoxication brings on perfect relaxation of the 
muscles. 

ANESTHESIA OF THE DOG AND CAT. 

In laboratories, for the performance of the operations necessitated 
by the study of physiology and experimental pathology (removal of 
the spleen,' of the kidneys, of the pancreas, of the liver, secretion of 
the stomach, or removal of the thyroid gland), anaesthesia of these 
animals is often required. But, for surgical operations, these animals 
are rarely put under the influence of an anaesthetic. Practitioners pre- 
fer to operate in private, with the subjects wholly conscious ; they 
thus avoid inopportune surprise and loss of time. Except laparatomy, 
Caesarian operations, the dislocation or removal of the crystalline 
lens, or the removal of some malignant' growths, operations can be 
easily performed on dogs without anaesthesia. Even kelotomy is 
a very simple operation, without narcosis. 

Some recommend ether, others prefer chloroform. In the case of 
carnivorous animals, since respiration takes place through the 
mouth as well as through the nose, it is dangerous to suppress the 
former air passage by closing it with a ligature or a muzzle. The 
dog should be held in a costal position, with its jaws free or kept 
apart with a speculum ; chloroform should be given through the 
nostrils or both through them and through the mouth, by placing 
near these openings a pad of wadding or a small sponge moist with 
chloroform. This process, as in the case of other animals, is not free 
from danger. Ether is administered in the same manner. 

To obtain a more rapid narcosis and reduce the dangers, the 



40 VETERINARY SURGICAL THERAPEUTICS. 

association of morphine with ether or chloroform has been recom- 
mended. Moller injects first under the skin 5 or 10 centigrammes of 
muriate of morphine, and after a short while, etherizes. Cagny 
administers vapor of ether through rectum. Others use morphine 
and chloroform. 

As in the case of horses, intravenous injection of chloral is 
dangerous. 

INIorphine in subcutaneous injections and chloral in enemas have 
been used with advantage (Cadeacand Malet, Esser, Guinard). Here 
is the formula of their use : 

Muriate of morphia, 5 milligrammes for each kilogramme. 
Chloral, i gramme. 

The objections are the same as for horses, — slow anaesthesia, 
abundant hemorrhage. 

Ch. Richet has recommended intraperitoneal injections of chloral 
alone or associated with morphine. Injected into the peritoneum, 
chloral brings, in about 10 minutes, a complete anaesthesia. The 
injection is made with a syringe of Pravaz sterilized. The intestines 
escape the needle and the peritoneum supports diluted chloral 
perfectly. 

Muriate of morphine added to chloral produces a longer anaesthesia 
(about an hour), and is said to be without danger of syncope. 
In this method, the doses are : 

INIuriate of morphine, 2.5 milligrammes for each kilograriime of the 
animal. 

Chloral, 5 decigrammes. 

Frohner has sometimes used urethane, hypnone and paraldehyde. 
But the most preferable method with this species of animal is that 
of Dastre and Morat. It consists in using chloroform after an injec- 
tion of apomorphine. With the morphine, the excitement of the 
beginning of anaesthesia is .suppressed ; with the atropine, cardiac 
syncope is prevented by arresting the functions of the cardial moder- 
ating center, and of the vaso-motor fibres of the pneumogastric 
nerve, " the centrifugal road of the syncopal reflex." Here is the 
method : First the solution of apomorphine is injected under the 
skin : 

Muriate of morphine 2 decigrammes. 

Sulphate of atropine 2 centigrammes. 

Distilled water 10 grammes. 

used in a dose of ^ cubic centimeter for each kilogramme of the 
weight pf the animal. 

When this solution has produced its effect (after 20 or 25 minutes), 
the inhalations of chloroform are begun. Several grammes are 
sufficient to produce a complete anaesthetic, which lasts one and two 
hours. 



AN.-ESTHESIA OF THE DOG AND CAT. 4I 

For man, Aubert has recommended the use of the following- 
mixture, which contains a smaller proportion of morphine, and 
especially of atropine : 

Muriate of morphine lo centigrammes. 

sulphate of atropine 5 milligrammes. 

Distilled water lo grammes. 

This solution is also preferable for dogs. Half of a cubic centimeter 
is an injection sufficiently large for a small-sized dog, one or two 
cubic centimeters for subjects of middle size, and three or four for 
large dogs. After 15 or 25 minutes, the chloroform is administered. 

By this process, a deep sleep of long duration is obtained — there 
is no danger of syncope. (Kaufman, Desoubry. ) 

Cats are very susceptible to the various anaesthetics. Administered 
in slightly too strong doses, or too rapidly, or for too long a time, 
there is danger of death. 

A simple and easy method consists in placing the animal under 
a glass bell, where small sponges, or pieces of wadding, moistened 
with chloroform have been placed. Soon the patient totters and 
falls ; it is taken from under the glass cover and operated upon. 
This manner of chloroforming is not without danger; it only 
produces short sleep, and if new inhalations are made, the animal 
may die. 

The process of Dastre and Morat is the best ; but as the cat is 
extremely sensitive lo the action of morphine, which produces in it 
a very strong excitement, the dose must not be above o gram. 0005 
(instead ogram. 005) for each kilogramme. Guinard, who gives the 
methods mentioned above, has also recommended another which 
allows one to bring about a long state of narcosis. He injects 
hypodermically muriate of morphine, in doses of ogram. 005 for 
each kilogramme of the animal ; then, as soon as the phenomena of 
excitement subside (after fifteen or twenty minutes), he places the 
cat under a glass bell with a few sponges impregnated with chloro- 
form. As soon as signs of narcosis are apparent, the animal is 
removed from the cover, and the inhalations continued a few 
moments. Anaesthesia lasting forty-five minutes can thus be obtained. 
The excitement which attended the taking of the morphine in the 
beginning reappears when the animal wakes up, and lasts sorrte time. 

ANAESTHESIA OF THE IMONKEY. 

The veterinarian may be called to perform some operations 
(puncture of abcesses, removal of tumors, or the extraction of the 
canines) on monkeys kept in captivity. Some of these animals are 
so easily handled that aneesthesia with them is useless ; but there 
are others which are strong and dangerous, and which must be 



42 VETERINARY SURGICAL THERAPEUTICS. 

ansesthesized. Chloroform is the best agent to use. This animal is 
placed in a narrow cage which is covered with a blanket ; at inter- 
vals of half a minute to a minute, balls of oakum or wadding 
moistened with chloroform are thrown into the cage ; soon the 
subject becomes benumbed, staggers, falls against the sides of the 
cage, crouches down ; now is the time to take hold of it — it is de- 
fenceless. (Percheron.) If the operation is to last some time, a few 
inhalations of chloroform are given. 

It is prudent to replace the animal in its cage until it has recovered. 

ANESTHESIA OF BIRDS. 

Narcosis is easily brought about in birds. Chloroform is more 
commonly used. The animal is placed under a glass bell, gently 
raised on one side to allow the entrance of air ; small balls of 
wadding saturated with chloroform are introduced under it. Soon 
the bird totters and goes to sleep without any symptoms of excite- 
ment. Inhalations can be kept up, if the operation is to last very long. 

Unless a subject is possessed of an excessive susceptibility to 
anaesthetics, — one of those "predisposed to" syncope," which one 
comes upon in all species, one may avoid complications and accidents 
by observing the following rules : Give anaesthetics to animals only 
when they have an empty stomach ; use a product pure and free 
from adulterations ; administer the ether or the chloroform slowly 
so as to allow also the entrance of a certain quantity of air ; if chloral 
is used, introduce the solution also very slowly ; and carefully watch 
the reflexes. 

In anaesthesia by ether or chloroform, there are at times, during the 
period of excitement, spells of coughing and panting for breath : 
these are of short duration. Yet, at this stage, the irritation of the 
mucous membranes of the first air passages may give rise to a 
respiratory syncope, which is also possible at the moment when the 
anaesthetic vapors make their impressions upon the encephalic 
elements, and later on, by bulbous intoxication. Respiratory 
syncope is indicated by superficial inspirations, very rapid, or 
sometimes very slow and incomplete. While the action of the 
heart persists, respiration can be re-animated by various means : 
slapping of the lips, of the face, or of the neck, methodic pressure 
upon the chest, rhythmic tractions of the tongue (Laborde), and 
artificial respiration. In complete anaesthesia, short arrests of respi- 
ration may be observed, which are syncopal in nature. 

Like respiratory syncope, c^rJ/ac sy«co/>e is precocious, secondary^ 
or terminal ; since it is brought on by the irritation of the pituitary, 
the sudden action of the anaesthetic upon the encephalon, or by 
bulbary saturation. It is manifested by repeated, very short, and 



LOCAL AN/ESTHESIA. 43 

later by intermittent arterial systole. As soon as the pulse is irreg- 
ular and the visible mucous membranes are becoming- pale, cardiac 
syncope is imminent ; inhalations must be suspended at once, the 
head inclined, the respiration kept up, and rhythmic traction upon 
the tongue performed. 

In small animals, during the ancesthetic sleep, it may happen that 
the tongue, retracted in the mouth, presses with its root against the 
epiglottis and closes the larynx. Respiration becomes embarrassed, 
and then its sounds suddenly cease. If this accident occur, tractions 
upon the tongue must be immediately applied to relieve the larynx. 

At the beginning of anaesthesia, in the stage of excitement, alarm- 
ing symptoms may be manifested (general stiffness, staring eyes, 
cyanosed membranes, and arrest of respiration), due to the closing of 
the glottis by spasms of the laryngeal muscles. If these symptoms 
appear, anaesthesia must be at once stopped, applications of cold 
water must be made upon the head and the face or chest slapped 
with a cloth dipped in cold water. 

Intoxication by the inhalation of too great a quantity of ether or chlo- 
roform is not to be feared unless anaesthesia has been badly applied 
or carried too far. 



LOCAL ANAESTHESIA. 

The dangers of general anaesthesia have suggested the idea of find- 
ing means by which only the region to be operated upon should be 
anaesthetized. Continued pressure over the tissues and the mediate 
compression on the nerves being very imperfect in their result, ice 
freezing mixtures or nebulization of ether have been successfully em- 
ployed. Then came cocaine, the use of which has now become 
general. 

Ax.%;sTHESiA BY CoLD. — I. Freezing Mixtures. — The continued ap- 
plication of cold upon superficial tissues produces in them modifica- 
tions, which bring on ischaemia, numbness, a diminution, and 
even an abolition, of sensibility. 

During this century cold has been resorted to for the purpose of 
performing some short operations upon the skin and the first sub- 
cutaneous layers, where refrigeration might, without inconvenience, 
be rapidly realized. 

In veterinary surgery it has been resorted to for operations on the 
lower parts of the extremities. Ice and common kitchen salt are 
mixed in equal parts or in the proportion of two to one. This mix- 
ture is placed in a bag or wrapped in a cloth and applied upon the 
parts to be operated upon. In a few minutes this becomes cold. 



44 



VETERINARY SURGICAL THERAPEUTICS. 



hard, and insensible, especially if, with this application, pressure is 
made upon the skin. 

The surgical action, when it is not too deep, produces no pain and 
no hemorrhage. But as the anaesthesia is of short duration one 
must operate quickly. 

2. Nehulization of Elher. — To produce local anaesthesia upon the 
operating field a throwing of vapors of ether has been tried. To 
increase the effects of the ether some was poured over the surface of 
the skin drop by drop and the evaporation stimulated either by a 
strong draft of air or by blowing over it with a bellows. Richard- 
son has rendered local etherization more practical by the use of the 
atomizer bearing his name, (Fig. 28.) With ether at 40° one may 
•obtain with this atomizer a local ischaemia and anaesthesia which 
permit a painless performance of slight operations (cutaneous diere- 
sis and exeresis). The action of the evaporation is more rapid and 




Fig. 28. — Richardson's atomizer. 



complete if, before the nebulization, a bandage o. Esmark has been 
applied. Inflamed structures are quite difficult to anaesthetize. For 
them freezing mixtures are better. 

Sulfide of Carbon possesses no advantage over ether. 

Chloride of Methylene, used with much success for man m obsti- 
nate cases of neuralgia, has a too powerful freezing action. It ren- 
ders the skin insensible in a few seconds, often freezing it, and 
■occasions a more or less extensive slough. 

AncBsthesia with Cocaine. — In 1862 Schroff had already shown that 
Ihe lingual mucous membrane could be rendered insensible with a 
solution of cocaine. The same result was observed by Fauvel in 
the case of the pharynx. In 1884 Roller recommended it as an excel- 
lent anaesthetic for the membranes of the eye and of the larynx. Vul- 



LOCAL AN.-ESTIIESIA. 45. 

pian and Panas made it popular in France. Reclus published some- 
excellent papers on its application. Labat proved that it could be 
used with benefit for animals. 

Cocaine is almost insoluble in water, but most of its salts in any 
proportion are readily dissolved by it. The most generally used is 
the muriate of cocaine in solution of i per 100. The addition of 
a small quantity of corrosive sublimate insures the purity of the 
solution for preservation. We use the formula recommended by 
Reclus. 

Muriate of cocaine lo centigrams 

Sublimate 2 milligrammes 

Distilled water lo grammes 

With a few drops of this collyrium dropped between the eyelids 
the superficial layers of the cornea are rendered insensible in three 
minutes. 

By repeating- this process at intervals of two minutes anaesthesia 
of the cornea, of the conjunctiva, and of the eyelids is complete in 
less than ten minutes, and lasts for fifteen. The pupil dilates ; but, 
generally, the anaesthesia of the iris is only obtained by an injection 
made into the anterior chamber. With cocaine, puncture of the 
cornea and the extraction of foreign bodies incrusted in it are made 
easily. Five or six injections under the conjunctiva, round the ball 
of the eye, will permit its entire removal without great pain. 

The action of cocaine is not less remarkable upon other mem- 
branes. On that account its use is prescribed for painful inflamma- 
tion of these structures. Subcutaneous and submucous injections 
of cocaine will remove sensibility from superficial tissues, and per- 
mit various operations to be performed. By injections in linear or 
circular tracts the area of the influence of the anaesthetic can be 
increased. A long and fine canula, fitted to a Pravaz syringe, is 
introduced through the skin into the subcutaneous cellular tissue, or, 
better, into the thick dermis, following the direction of the incision to- 
be made. Then it is withdrawn gradually while the piston of the 
syringe is pushed in. In this way the solution is diffused in a linear 
track. (Reclus.) The anaesthetic power of cocaine is increased by 
a previous injection of morphine. 

Cocaine has no action upon nervous cells. It acts exclusively 
upon the terminal fibres of the sensitive branches. (Arloing. ) 

Its toxicity varies according to the kind of animal. For dogs, 
more than 5 to 10 centigrammes are dangerous. Concentrated solu- 
tions have no advantages and are dangerous. In every degree of 
concentration, solutions of cocaine, when they become acid, lose, 
more or less completely, their anaesthetic properties, which can be- 
restored if the liquid is rendered neutral. 



46 VETERINARY SURGICAL THERAPEUTICS. 

III. 
SURGICAL ANTISEPSIS AND ASEPSIS. 

Although infectious complications of traumatism have, at all times, 
occupied the attention of surgeons, until modern times surgical art 
was powerless to prevent them, because their nature and their par- 
ticular cause were unknown. In the first part of this century, they 
were supposed to be due to the action, upon the exposed wounds, 
of the impurity and vicious condition of the atmosphere of hospitals, 
or of the air loaded with the viiasinas of putrefaction. The labors of 
Pasteur and of Tyndall seemed to justify the correctness of this 
idea, although they showed that it is not the air itself which pos- 
sesses injurious properties, but the germs that it contains in sus- 
pension. 

While organic substances exposed to the action of the air enter 
immediately into fermentation, they do not undergo any kind of 
alteration in contact with air optically pure, which has been filtered 
through wadding. It is the animated atoms, the germs in suspen- 
sion in the atmosphere, the microbes, which give rise to the decom- 
position of those substances and to the putrefaction which is devel- 
oped in the tissues as soon as life has left them. Without micro- 
germs there would be no decomposition or no putrefaction. Logic- 
ally, it became evident that the same process ought to take place in 
wounded structures, exposed to the action of air, and of its germs. 
The phenomena which characterize septic complications of wounds 
should be essentially those occurring in fermentations. 

The first important researches made for the purpose of preventing 
these complications are comparatively recent. It was in 1861 that 
Lister, inspired by the labors of Pasteur upon the subject of fermen- 
tation, made the experiments which brought him to conceive of the 
antiseptic method ; and in 1870, A. Guerin, guided by the same dis- 
coveries and those of Tyndall, originated the wadded dressing. It 
is but just to say, that in 1865, Lefort had already said that conta- 
gion is the great cause of those complications. 

Guerin, in the case of wounds, realized the experimental condi- 
tions which protect qrganic matter from the alterations of which the 
micro-organisms of the air are the agents ; with thick layers of wad- 
ding he protected the divided tissues from the action of germs. 
Lister had for object to destroy, with chemical agents, the microbes 
which corrupted the wound or which might be deposited in it dur- 
ing the operation ; he rendered the wound aseptic and then pro- 
tected it by a true germicide obstacle. 

Let us first consider the wadded dressing. 

At first Guerin did not attempt to obtain immediate union ; he 



SURGICAL ANTISEPSIS AND ASEPSIS. 47 

only tried to reduce to the minimum the secretions and prevent acci- 
dents from infections. Hemostasis insured, he washed the wound 
with tepid water, then with a mixture of water and camphorated 
alcohol ; in some cases he saturated the wound with it, cut the 
threads of the sutures close to the skin, and then covered the whole 
with several layers of wadding-. In serious operations upon the ex- 
tremities, those were wrapped up in sheets of wadding superposed 
in such a way that the leg seemed to be three times its ordinary size. 
The wadding- was then fixed tight with linen bands properly applied ; 
the whole of it was to be sufficiently pressed to give on percussion 
" a resonance resembling that of the normal thoracic cavity." If, on 
the following days, the degree of pressure proved insufficient, new 
bands were applied, and if the dressing appeared to be run through 
by the serosity of the wound, other layers of wadding were applied 
over it. This dressing was first left in place for 20 or 25 days ; 
later, it was changed after 12 or 15 days. Generally, when the first 
dressing was taken off, the wound was granulating throughout its. 
whole, extent. After a second dressing, having been left 8 or 10 
days, often cicatrization was complete. 

Several modifications of this method have been introduced which 
permitted reunion by the first intention. First, the hemostasis was 
made more vigorous and the edges of the wound were fixed together 
with absorbable thread (catgut) placed more or less deeply. Besides 
its numerous advantages, the wadding-dressing had the disadvan- 
tage of concealing from the surgeon the condition of the trauma- 
tism. It is true the thermometric observations informed him of the 
complications likely to occur ; but as it sometimes happens that 
thermometric elevations show themselves in the case of patients 
whose wounds are doing well, much time was lost, and patients 
were exposed to complications by uncovering wounds in process of 
cicatrization. And again, although in protecting the wounds by- 
layers of wadding atmospheric germs were prevented from reach- 
ing the divided tissues, those which had already been deposited on 
them during the operation were not destroyed ; and these, though 
under restraint {mal a Taise), were nevertheless multiplying, often 
with great rapidity. 

Still, compared with the old dressings, the wadded apparatus was 
an immense advance in the surgical art. It was employed, how- 
ever, but little ; and was obliged to make room for the Listerian 
dressing, more practical and more trustworthy in its results. 

To prevent the infection of the wound, Lister strived to surround 
it with an atmosphere freed from infectious elements and to destroy 
the germs of the surrounding aerial layer, those deposited on the sur- 
face of the wound, on the hands of the surgeon and his assistants, 
upon the instruments, the sponges, the compresses, and all objects 



48 VETERINARY SURGICAL THERAPEUTICS. 

of dressing'. The wound, free from infectious germs, was covered 
with material impregnated with an antiseptic, and care was taken to 
prevent the accumulation of the serosity secreted by the wounded 
surfaces. As microbicide agents, Lister used especially phenic acid, and 
in I to 20 solution (strong) or i to 40 (weak). With the strong solu- 
tion, he disinfected the instruments, the sponges and the region ; 
and, when the operation was concluded, the wound over its whole 
surface. The weak solution was used to wash the hands of the sur- 
geon and assistants, to moisten the sponges and clean them during- 
the operation. To prevent the contamination of the wound by 
atmospheric germs during the operation, a " phenicated cloud" 
{spray), made with a Richardson atomizer or a vapor nebulizer and a 
solution of phenic acid, was thrown over the field of operation. After 
the operation, and before the spray was arrested, as soon as hemo- 
stasis was obtained, by catgut ligatures cut short to the knot, the 
edges of the wound were brought together with sutures of the same 
nature. Drainage tubes were fixed to allow the escape of the 
secreted fluids, and the dressing was applied. 

The region of operation was first covered with a pj-o/eclivehcivA of 
silk, very thin, gummed, and impermeable, for the purpose of pre- 
venting the prolonged action upon the wound of the too irritating- 
phenol ; above this, phenicated (carbolated) gauze folded in eight 
layers, the last two having between them an impermeable cover of 
caoutchouc to prevent the evaporation of the phenol and oblige the 
liquids secreted by the wounds to run through the whole thickness 
of the dressing before reaching the outside. All of these were kept 
in place by bands of carbolated gauze. Since the action of the phe- 
nol upon living tissues gives rise to an abundant secretion, the 
dressing ought to be taken off after 24 or 48 hours, the wound exam- 
ined, as also the sutures and the drains ; if necessary, take these off, 
and replace them after a thorough washing with a solution of phe- 
nic acid, and then a new dressing applied. All of this should be done 
under the spray. Later dressings more or less frequent were made 
with the same care; the wound was looked at only when it became 
painful or when there was a noticeable rise of temperature. Such 
was the method used for wounds in operations made upon tissues 
free from all external contamination. 

For recent traumatic lesions more or less irregular, the application 
of the dressing was preceded by a careful washing made with a con- 
centrated solution of phenic acid (i to 10). Suppurating wounds required 
a more complicated preparation ; they were first treated with the 
curette, then very carefully washed with a solution of chloride of 
zinc (i to 10). As the irritating action of the phenol was not to be 
feared, the protective band was dispensed with. 

The Listerian dressing extolled by Championniere and Terrier in 



SURGICAL ANTISEPSIS AND ASEPSIS. 49 

France, and by Wolkmann and Billroth in Germany, soon became 
popular in every country. Everywhere it took the place of the old 
ones ; but, advantageous as it was, it was soon found to have many 
faults ; such as, its many details, and the time required to apply it, 
its expensiveness, and the toxicity of the phenic acid. Everywhere, sur- 
geons set about improving it, and above all simplifying it, while re- 
specting the principal rules established by its author. For phenic 
(phenol) acid, Thiersch substituted salicylic acid ; Lewin, thymic 
acid ; Kocher, chloride of zinc and sub-nitrate of bismuth ; Bergmann, 
corrosive sublimate ; Mosetig-Moorhof, iodoform. The phenicated 
gauze was replaced by rough netting (gauze) kept in phenol (vi^eak 
solution) until ready to use (Bardeleben), and by muslin soaked for 
a week in a strong phenic solution (Bceckel). Neuber proposed to 
use for drainage, tubes made of decalcified bones, which would be 
resorbent, irritate the tissues but little, and avoid the too frequent 
renewal of the dressing. The protective band was recognized as 
useless, and drainage was used only when it was pretty evident 
that immediate reunion would not take place. The technic of the 
dressing, the microbicide agents, and the strength of the solution, 
were all changed indefinitely. 

Guerin, holding to the principal idea resulting from the new doc- 
trine, prevented the entrance into the wound of the germs of the 
air. He was less occupied with the infection through the hands, 
instruments and objects of dressings ; and if he nevertheless ob- 
tained good results, he owed them in a great part to "cleanliness," 
to an excellent habit which he had, before working, of washing his 
hands and cleaning with soap and camphorated alcohol the region 
to be operated upon and its surroundings. 

Lister's method was more sure, but it also had its imperfections 
and its errors. Evidently the success which marked the beginning 
of antisepsis was not exclusively due to phenic acid. To it v;as at- 
tributed a vigorous bactericide action that it did not possess. The 
belief in rapid and complete disinfection, by phenic acid, of the in- 
struments, hands, and operative field were fallacious. In the pro- 
cess of Lister, as in that of Guerin, what was important was the 
severe cleanliness of the hands, instruments, and objects of dress- 
ing. Notwithstanding phenic acid, say Terrillon and Chaput, "an- 
tisepsis would never have come out of its limbus if cleanliness had 
not helped it to make its entrance into the world." ' 

Protect the wounds from the action of the germs of the air. Such 
was the great occupation of Guerin, and of Lister himself. But 
numerous observations have shown that infection of wounds is 
almost always produced by the hands of the operator or of his as- 
sistants, by the instruments, the objects used for dressings, the 

' Terrillon and Chaput — Asefsie and antisepsie chirurgicales, p. 4. 

4 



50 VETERINARY SURGICAL THERAPEUTICS. 

liquids used, and not by atmospheric germs. Contrary to what was' 
taught at the beginning of antisepsis, the air is in reality but little 
to be feared for the wounded ; its microbes, thought so dangerous, 
are almost harmless. When they fall, scattered upon the wound, 
the phagocytes generally are sufficient to destroy them ; those which 
are carried into it "in legions" by " the dirty hands," the uncleaned 
instruments, the unprepared materials of dressing, are much more 
dangerous. Numerous facts borrowed from veterinary path- 
ology can be cited in favor of the "germ contage. " Septicaemia, 
which in other times burst out so frequently after operations per- 
formed in our hospitals, was not due, as was believed, to the deposit 
of atmospheric germs upon wounds ; it was inoculated by the dirty 
instruments, which were transferred from the post mortem rooms to 
the surgical amphitheaters without being cleaned, or only after a 
semblance of cleaning. We can daily violate the old dogma of re- 
spect for the sero-sanguineous collections of the horse, because we 
open them with aseptic instruments. It is the same with the septi- 
ca^mic spores. How many times those of tetanus have been inocu- 
lated by the instruments ! To speak only of castration, how many 
victims have there been to the twisting nippers {pi7ice a torsion) 
whose jaws, notwithstanding "good washings," retained in their 
rough teeth the dangerous virus. 

When the principal mode of contamination of wounds was known, 
careful attention was given to the disinfection of instruments, of 
hands, and of the dressing material. Bacteriological researches, and 
failures in some operations, showed that the disinfection by chemi- 
cal agents was not always complete, even with the use of concen- 
trated solutions. Organic substances are not easily penetrated by 
antiseptic liquids ; no matter how thin they may be, it is possible 
that their deep parts remain virulent notwithstanding the continued 
action of these liquids. Their use was kept up to disinfect the hands 
and the portion operated upon ; then heat and high temperatures 
were used to sterilize the instruments, ligatures, drains and other 
objects of dressing. 

Passing them through the flame of an alcoholic lamp, immersing 
them in boiling water, in glycerine, or oil heated to i20°-i5o'^, are 
the sterilizing modes now most in use. The simplest and most prac- 
tical is certainly boiling water. It does not give an absolute secur- 
ity, some spores resisting a temperature of ioo° ; it almost always 
offers, however, sufficient guarantee. 

In hospitals, the autoclave of Chamberland and the dry ovens are 
very advantageous, the former for sterilization of objects preserved 
in liquids (i20°-i5o°). 

In these last years, while in the old world vigorous antisepsis 
has been practised and its methods perfected, English and Ameri- 



SURGICAL ANTISEPSIS AND ASEPSIS. 5 1 

can surgeons have given up bactericide agents to be satisfied with 
strict cleanliness. They put antisepsis aside for asepsis. But this 
cannot be accepted in veterinary medicine, at least, as a general 
method. There is no necessity of studying them separately any- 
how ; they mutually complete each other, and their association is 
often advantageous. Antisepsis must be applied when the operation 
may be followed by abundant suppuration, a fistulous tract, or an 
iilcer, and also after interferences in which union by first intention 
has failed to take place ; its agents are always used to disinfect the 
part operated upon, the hands, and the instruments, and to prepare 
the material of the dressing. One is satisfied with asepsis alone 
when only tissues free from any contamination are to be divided, 
and when antisepsis might, by their contact, give rise to inflammation, 
limited necrosis, and intoxication ; but although, when one is certain 
of asepsis, it is useless to place healthy divided tissues in contact 
with strong antiseptic solutions, very often, during operations, the 
veterinarian is obliged to have recourse to those solutions in order to 
purify the tissues accidently contaminated. 

Of the two problems, ' ' antisepsis before and during "or " antisepsis 
before,and asepsis during" an operation, it is the former that we pre- 
fer as a general rule in our own practice, where during operations, 
on account of the conditions in which they are performed, the 
chances of infection of the wound, of the hands and of instruments 
are very numerous and difficult to avoid. 

Even in human surgery, where strict asepsis can, perhaps, be ob- 
tained more easily, — thanks to the places well arranged for it, and to 
the use of special apparatus, — and where the operator is aided by a 
selected staff and well-trained assistants, antisepsis has also its ad- 
vantages. In general, says Terrier, "with a view to greater 
certainty from an operative standpoint, it would be well always to 
reserve antisepsis for certain things, even while one should give his 
preference to the mixed method. . . . Since the organization of our 
hospitals is so insufficient as it is, the mixed method seems to offer 
us more security than the pure aseptic process. " ' 

Among the agents which give rise to infection in surgery, there 
are those which assume a single form (micrococci) ; others have 
morphological characters which differ according to their stage of 
evolution (bacilli). While the former are generally rapidly killed by 
heat and by antiseptic agents, the latter have a resistance to the 
causes of destruction, which varies according as they are under 
the form of bacilli or in the state of "germ-corpuscles." When they 
have become adults, they are easily killed ; but under the form of 
spores, they possess a very great resistance to germicide agents^ 

I Terrier et Peraire, " Manuel d'antisepsie et d'asepsie chirurgicales," p. 123. 



52 VETERINARY SURGICAL THERAPEUTICS. 

Some spores (tetanus, septicaemia) are possessed of an extraordinary^ 
vitality. 

All microbes resist heat and antiseptics much better and much 
longer in dry than in damp media. An excellent way of effecting- 
their complete destruction, is to expose them to damp heat. 
While most of the pathogenic microbes may be killed with steam, 
to obtain the same result with dry heat, a temperature of 130° to 
150° is required. With the assistance of moisture, the potency of 
high temperature and of chemical antiseptics is considerably in- 
creased. Submitted to the action of damp heat, most of the adult 
pathogenic microbes do not stand a temperature of 100° more 
than a few minutes ; boiling water is sufficient to destroy them ; 
also strong antiseptic solutions. Many die at 80^-70°, and even 
65'', but to destroy tetanic, septic, and some other spores, tempera- 
tures higher than 100° are required. 

The following table shows the temperatures at which, in damp 
media, the pathogenic agents, which are most interesting to us, 
are killed : 

The staphylococcus aureus is killed in ten minutes by a temperature of 58° 

— albus — — 62° 

— citreus — — 62° 
The streptococcus of erysipelas — — 58° 
The distemper — — 60° 
The bacillus of tetanus — — 75° 

— tuberculctsis — — 75° 

— glanders — — 55° 
The bacteroids — — 55° 
The anthrax spores — — 100° 
The tetanic — — — 105° 
The septicamic — — — 120° 

The teia?iic virus (spores) is destroyed in 15 minutes with a tem- 
perature of loo'^ ; in five at 115°. It resists nearly 10 hours, in a 
cold, strong phenicated solution (5 percent.), and for more than three- 
hours in a Van Swieten solution. 

YxQsh. septiccB77iic virus resists 15 minutes, with a heat of 100° ; with 
dry heat it is destroyed in 10 minutes at 120°. 

Freshvirus of sy77iptomatic anthrax is destroyed in two minutes by 
immersion in boiling water. If it is dry, it stands 10 minutes a heat 
of 120°. 

Also, fresh virus of bacieriaTt anthrax (spores) is destroyed in a few" 
minutes by heat at 100° — 105°, if it is dry. To obtain the same 
result, a temperature of 115^ for 10 minutes will be required. 

ANTISEPTIC AGENTS. 

Let us briefly consider the principal antiseptic agents, and indicate 
their use and modes of application. 

'Wiih. phe?iic acid, solutions of i, 2 or 5 per cent, are made. The 



ANTISEPTIC AGENTS. 53 

strong solution (5 per cent) can be used to disinfect instruments and 
the operating field, to cleanse abscesses, suppurating surfaces, and to 
stimulate a slight adhesive inflammation in intestinal sutures(Chaput). 
It should not be used for wounds consequent on the operations 
or for recent injuries, where cicatrization by first intention is looked 
for, because it greatly irritates the tissues, and produces a serious 
hypersecretion which prevents immediate union. The weak solution 
(2 per cent) is proper for the washing of recent wounds, and the 
<lisinfection of the hands during the operation. A solution at i per 
cent is employed for the disinfection of some mucous membranes and 
for obstetrical operations. 

Bichloride of mercury {sublimate) is one of the most powerful chem- 
ical antiseptics. Koch has shown that a solution of i to 1000 
■destroys in a few minutes bacteria and most of the spore-micro- 
'organisms. On account of its toxicity, many surgeons use it only 
for the disinfection of the skin and of the vaginal mucous mem- 
branes ; they find it dangerous for other membranes and for 
bleeding surfaces. It may, however, be used in weak solution for 
the washing of wounds made by the operations, or those which 
are the result of accidents ; it irritates less than phenic acid. Its 
use is not advised for the disinfection of metallic instruments ; it 
blackens them and destroys their polish and their sharpness. Some 
practitioners, in its place, use the bi-iodide of mercury for obstetrical 
•operations and the oxycyanide of mercury for the preparation of 
the instruments. (Chibret, Trasbot). 

The strong aqueous solution of corrosive sublimate is made as 
follows : 

Corrosive sublimate i gramme 

Tartaric acid 5 do 

Boiled water looo do 

The weak solution is obtained by adding looo grammes of water 
to the preceding. Solutions of i to 3000 or i to 5000 can be used for 
asepsis of most of the mucous membranes. With the lozenges and 
the wafers of sublimate made use of to-day, nothing is easier than 
to prepare those solutions extemporaneously. 

The alcoholic solution of corrosive sublimate — excellent for the disin- 
fection of the hands, and of the operating field — and sublimated 
■xaseliiie are prepared as follows : 

A Icoholic solution. 

Corrosive sublimate 2 grammes 

Alcohol (90°) looo grammes 

Sublimated vaseline. 

Corrosive sublimate i gramme 

Alcohol 10 grammes 

Vaseline 1000 grammes 



54 VETERINARY SURGICAL THERAPEUTICS. 

Chloride of zinc, used by old surgeons for the treatment of wounds 
of a bad nature, is a powerful antiseptic. In concentrated solution 
(5 per cent) it rapidly destroys most of the spores (Koch), but is- 
caustic. Solution of i in 10 is advantageous to disinfect fistula, 
abscesses, and suppurating or septic wounds. Socin's paste (50 
parts of oxide of zinc, 50 of water, 5 or 6 of chloride of zinc), recom- 
mended in Veterinary Medicine by Cagny, forms for aseptic sutured 
wounds a protective varnish which may be used for dressing. It is 
especially used for wounds of the head and of the superior parts of 
the trunk. 

Potassium permanganate is also a good antiseptic. Free from all 
toxicity, it owes its microbicide properties to the oxygen that it gives 
out. Without irritating action upon tissues, it can be used on all 
wounds, specially those of the mucous membranes. Soluble in 
water in all proportions, it is easy of application. In solution of i 
to 1000 it is advantageous for disinfecting the mouth, the nasal 
cavities, the vagina, rectum and the wounds of cavities (serous). 
The strong solution is utilized (10 in 100) for injected wounds and 
for the asepsis of the hands. To remove the discoloration that it 
leaves, it is sufficient to dip them into a solution of bisulphite of 
sodium (10 in 100), to which is added a few drops of chlorhydric 
acid. 

Biniodide of mercury, whose germicide power is reported to be 
equivalent to thirty times that of corrosive sublimate, is used in 
solution of I in 10 or 20,000 for the disinfection of the ocular and 
uterine mucous membranes. It is not irritating to the hands or to the 
edges of wounds, and it does not injure instruments. 

Iodoform, used for a long time now in the treatment of wounds 
and ulcers (Demarquay, Lallier, Besnier, Fereol) is a costly antisep- 
tic. Its action is slow, but lasting. Both antiseptic and analgesic, 
it quickens cicatrization of wounds, interferes with the decomposi- 
tion of fluids that they secrete, and diminishes the soreness. A 
small quantity sprinkled upon bleeding tissues before they are 
brought together, does not prevent immediate union. Laid, even 
in thin layer, in wounds with loss of substance, it keeps them in an 
aseptic state for five, six or seven days, forming a kind of reserve for 
constant disinfection. (Forgue and Reclus. ) Employed in large 
quantities upon recent wooinds, on subjects provided with adipose 
tissues, principally obese dogs, it may be dissolved by the bloody 
secretion, by the fat, and give rise to intoxication. Its inconveni- 
ences for veterinary use are its disagreeble odor and its comparatively 
high price. It is generally applied as a fine powder, but sometimes 
under other forms. The most used preparations are : 

lodoforviect ether. 

Iodoform 7 to lo grammes 

Ether 100 grammes 



ANTISEPTIC AGENTS. 55 

Glycerine emulsion. 

Iodoform 10 grammes 

Glycerine 100 grammes 

, Iodoform ointment. 

Iodoform 7 to 2 grammes 

Vaseline 10 grammes 

Iodoform is fixed upon gauze or wadding. 

Iodoform gauzes are generally used in antiseptic dressings. They 
contain lo, 20 or 30 per cent of iodoform. lodo/orni wadding \s\xse6. 
to fill cavities, or in dressings following operations on the vagina. 

Di~iodo/orm, a relative of iodoform, into the constitution of which 
enter 95 per cent of iodine, while iodoform contains but 69 per cent, 
is a yellow substance, insoluble in water, but little soluble in alcohol, 
very soluble in most of the hydrocarbons. It keeps indefinitely 
without alteration in the dark, but is very sensitive to the action of 
light. Inodorous and antiseptic, it is one of the most powerful cica- 
trizing agents known. Its microbicide power is comparatively 
small. (Maquenne. ) 

lodol, less odorous and less toxic than iodoform, possesses 
similar properties, and is used for the same purposes. lodol gauze, 
vaseline and collodion are prepared with it. 

Salol contains 40 per cent of carbolic acid. Used as powder, like 
iodoform, it has the advantage of having no disagreeable odor. It 
serves for the making of antiseptic gauze and wadding. 

Cresyl (creolin) is much used as an antiseptic in Veterinary 
Surgery. Of moderate price, soluble in all proportions with water, 
alcohol and glycerine, having but a very weak toxicity, neither 
altering instruments nor discoloring the hands, it is simple and ad- 
vantageous in use. The strong solution (3 to 5 per cent) is employed 
for disinfection of the operative field, the hands, instruments, and 
the treatment of infected wounds. The weak solution (i per cent) 
may be used on bleeding wounds and mucous membranes ; it is ex- 
tensively used in obstetrical operations, and for the disinfection of 
the uterus. Cresyl is not good to use in the preparation for dipping 
the instruments during operations ; it renders them slippery and the 
white mixture it makes prevents their being distinguished and taken 
out with ease. 

Here are the two most generally used formulas : 

Cresylated alcohol. 

Cresyl i gramme 

Alcohol (90*) 10 grammes 

Cresylated vaseline. 

Cr«syl ■ I gramme 

Vaseline lo grammes 

Trichloride of Iodine is an antiseptic almost as active as corrosive 



56 VETERINARY SURGICAL THERAPEUTICS. 

sublimate (Langenbuch, Kitasato). It can be used to disinfect the 
hands, the operative field, the instruments, and the material for 
dressings. 

Pure tincture of iodine may take the place of strong antiseptic 
solutions for the disinfection of suppurative wounds. 

Chloral, in solution of i per cent, is only used for antisepsis of 
the mouth or of the rectum. 

Nitrate of silver, in strong (i in 50-100) or weak solution (i in 
1000), is used successfully to obtain the disinfection of some in- 
flamed mucous membranes. 

Boric acid, in concentrated solution (3-4 in 100) is far from pos- 
sessing the antiseptic properties attributed to it by Lister. About 
five times less active than phenic acid and a hundred times less than 
corrosive sublimate, it is used only in the antisepsis of the mucous 
membranes (eye, nasal and buccal cavities, ear, rectum, vagina and 
bladder). 

Naphthol, in solution i in 1000, is also a weak antiseptic. 

Naphthaline, which has the same properties as naphthol, exerts an 
irritating action upon the tissues, and stimulates the granulation of 
wounds. 

Camphorated naphthol is a light yellow or brownish yellow syrupy 
product, prepared by triturating one part of naphthol with two of 
camphor. Camphorated salol, a whitish liquid, is obtained b}?- warm- 
ing together equal parts of salol and pulverized camphor. Camphor- 
ated thymol, an almost limpid liquid, is prepared by triturating one 
part of thymol with two of camphor. These three products are 
utilized in the treatment of suppurating wounds. 

Boiled salt ivater (6 or 7 grammes of salt to each litre of water) is 
excellent for peritoneal irrigation in operations made on the abdomi- 
nal cavity (Kocher, Tavel). 

We must also mention thymol, lysol, solutol, salveol, derjuatol, chlo- 
ral, chlorine water, sanitas, several essences, microcidine, alcohol, tan- 
nic acid, salicylic acid, and sub-nitrate of bismuth. These last three 
are used in thin layers, or blown upon the wounds. 

The number of antiseptics is increasing every day, but the latest 
offer no real superiority over those used in the beginning. Carbolic 
acid, corrosive sublimate, chloride of zinc, and iodoform, equal all 
the others. 

INSTRUMENTS— DRESSING MATERIAL. 

Instruments entirely of metal, without useless grooving, and as 
simple as possible, are used in preference to all others. Compli- 
cated instruments, or those invented for the execution of special 
operations, are more useful in the show cases of the instrument 



INSTRUMENTS — DRESSING MATERIAL. 5/ 

makers, or of colleges and museums. Veterinarians must accustom 
themselves to do without them ; they are, however, only useful for 
unskilful surgeons. Every practitioner knows that with a simple 
probe-pointed bistoury the neck of the vaginal sheath is more easily 
divided than with any of the herniotomy knives. One of us has 
shown that the complicated establishment, built thirty years ago for 
the ovariotomy of large domestic females, is no longer of other 
than historical interest. The Chassaignac, well made and well 
handled, is better than any of the improved ecraseurs. To these 
we could add many other examples. 

In rural practice a decorated surgical outfit would be a useless 
luxury. 

The material for dressings consists of wadding, oakum, silk, 
Florence hair, horse hair, Breton thread, sponges, compresses, 
gauze, bandages, and coarse nettings. 

Waddt7ig is an excellent material, not irritating to the tissues ; 
it possesses remarkable absorbing properties. It is rather costly. 
For large animals one can make with it the first layer of dressing for 
serious wounds occasioned either by operations or by severe acci- 
dents ; it is used in large quantities only for small subjects and ex- 
pensive animals. Peat ivaddiiig {oiiaie de iourbc), readily absorb- 
ing, supple, elastic, cheap (cheaper than oakum), is very good for 
all cases. Wood wadding, used by Moller at Berlin, has the same 
qualities. Oakum is found everywhere, but is inferior to the pre- 
ceding. Gauze, a good absorbent, and not irritating to wounds, is, 
like wadding, too expensive for animals ; it is used only for severe 
traumatisms and costly animals. Most sutures are made with silk 
or thread ; hair and catgut are less used. Ordinary silk, flat or 
braided, the last preferably, are generally employed. They are of 
various sizes. To envelope the surface operated upon, compresses 
are made of coarse netting, gauze or old linen ; to dry the wounds, 
small compresses are preferable to sponges. Dressings are secured 
with ordinary bands, or, more economically, with coarse netting 
made into bandages 6 or 8 centimeters wide. 

TECHNIC OF ANTISEPSY AND ASEPSY. 

Let us now consider what antiseptics, in general practice, are to 
be used preferably for the disinfection of the hands (surgeons and 
assistants), of the instruments and objects of dressing, and of the 
operative field, and how they are to be applied. 

Disinfection of the Hands. — The experirrients of Fiirbringer on this 
subject have shown that asepsis of the hands is not easily realized. 
It is, however, of importance, because, as said by Lefort thirty years 
ago, very often the hand is the agent of the infection of operative 
wounds. The surgeon who does not wish to meet with trouble 



58 VETERINARY SURGICAL THERAPEUTICS. 

must have his hands perfectly clean. The nails, the sub-ungual 
spaces, chaps, wrinkles, and the pores of the skin are true " micro- 
bic dens," and to destroy all of these microbes, the greatest care- 
is necessary. There are even cases where, no matter what is 
done, hands cannot be rendered completely aseptic. Kiimmel, Fiir- 
bringer, and Terrillon have observed that when they have been 
soiled with pus, putrid or septic liquids (interference with injected 
wounds, post-mortem), it is impossible to render them absolutely 
sterile for forty-eight hours. This is a fact that surgeons must 
bear in mind, when they are about to operate upon the abdomen 
(laparotomy, cryptorchidy, ovariotomy) ; it imposes, when possible, 
the postponement of an operation for several days, and also greater 
care when th@ case does not permit of postponement ; and it explains 
perfectly the failures which sometimes occur when one thinks he 
has followed all the rules and should have been successful. 

The toilet of the hands begins with the mechanical cleaning of 
nails, dry, and cut short ; then the hands and forearms should be 
washed with soap and warm boiled water, and rubbed with a brush 
or a coarse towel ; they should be washed a second time with alcohol 
at 80°, then a third time with a solution of corrosive sublimate of 
i-iooo. Alcohol is very advantageous to dissolve the greasy sub- 
stances which interfere with the effect of the antiseptic bath. 

More complex procedures have been recommended, but this one 
is sufficient ; and in our surgery most commonly the care of the nails, 
and the washing with soap and boiled water, followed by one with a 
corrosive sublimate solution i to 1000, orcresyl 3 p. c. , are all that is 
done. The hands must remain free from all dirt during the whole 
operation, " aseptic they must be, aseptic they must remain." One 
should be careful not to touch with them the skin of the surrounding 
parts, nor the table upon which the animal lies, nor the straw, — in 
fact, any.object not disinfected. Even when no suspicious substance 
has been touched, it is proper, during the operation, to dip the hands 
now and then in the Van Swieten solution ; and whenever they have 
lost their " antiseptic virginity," the whole process of cleaning must 
be done over again (Forgue and Reclus). This has to be done 
often during operations performed upon animals ; and this rule 
must be severely followed, especially when manipulations are made 
about the peritoneal cavity. In those cases, a simple oversight of 
this kind may be the cause of the death of the patient. 

Covered with a blouse or with an apron, the operator should have 
the shirt sleeves rolled up. It is wise for those who perform 
delicate operations, and who wish to obtain adhesive cicatrization, 
to keep their beards and hair short ; all rings and jewels would 
better be removed, so that the hands may be perfectly free when 
working on the abdomen. 



TECHNIC OF ANTISEPSY AND ASEPSY. 



59 



Disin/eciion of Instriwients. — The handles of instruments should. 
be plated with nickel or aluminium. (Ficj. 29.) Rough surfaces, 
grooved jaws, joints of forceps, the ends of grooved probes, and 
the eyes of needles should be carefully looked after. Complicated 
instruments, and those difficult to clean, should be avoided. For 
sutures, the needles of Larger or of Lamblin (figs. 30, 31, 32) are pre- 
ferable to all others ; they are simple and of easy aseptisation. Instead 
of syringes for injections, glass funnels with disinfected India rubber 
tubes are preferable. A number of ways and of agents have been 



Ulil 

Fig. 29. — Bistouries with metallic handles. 

recommended to render instruments aseptic. Soaking in a strong 
phenic or cresylic solution is a method used by some ; but phenic 
acid dulls the edges of the bistouries, and cresylic makes them 
greasy and slippery, and the opacity of the emulsion prevents their 
being seen through the vase where they are deposited. Immersion 
in boiling water is simple and practical. The degree of ebullition of 
the water can be raised by adding common salt, or carbonate of soda, 
(Bergmann, Schimmelbusch), or carbonate of potash (Terrier), or 
chloride of calcium (Redard). Alteration of the instruments is pre- 
vented by adding to the water I percent, of caustic soda. Baths of oil, 
glycerine, or liquid vaseline, at a temperature of 1 20^ to 1 30*^, produce 
a complete disinfection. When instruments are soiled by some vir- 
ulent matter, such as proceeds from a septic or tetanic center, the best 
•way to render them aseptic is to dip them for 10 or 15 minutes in a 



6o 



VETERINARY SURGICAL THERAPEUTICS. 



bath of oil or of glycerine. Except in such cases, boiling in ordinary- 
water or in a solution of carbonate of soda (104°) is sufficient. In- 
struments with wooden handles are spoiled by boiling ; with them, 
a careful cleaning of the handle is necessary ; the blade alone is dis- 




\2- 



■ 



Fig. 30. 



Fig. 3 1 . 



Fig. 32. 



Reverdin's needle. Larger's needle. Lamblin's needle. 

infected in boiling water. The autoclave, and damp or dry ovens 
are the apparatus of the laboratory, or for surgery in hospitals. 
Passing through the flame of an alcoholic lamp, Tedenat's "punch for 
instruments" is also a rapid way of disinfecting them. The instru- 
ments are placed on a metallic plate, and some alcohol is poured 
over them and lighted ; a few minutes are sufficient for their sterili- 
zation. They are then placed in a weak antiseptic solution or in 
boiled water. Although this process is excellent for ecraseurs, forceps 



TECIINIC OF ANTISEPSY AND ASEPSY. 6 1 

and probes, it has the objection that.it softens the edges of the bis- 
touries, sage knives and scissors. Gum probes should be cleaned 
■with alcohol at 70°, and then in a corrosive sublimate solution of i to 
1 , 000. 

Besides instruments, there are sponges, balls of cotton, of oakum, 
compresses, threads and other objects of dressing used by the sur- 
geon. All this surgical material must have received a special prep- 
aration — it must be aseptic. This is the way to do it : 

Sponges are cleaned under running water after being freed of their 
dirt by hammering them with a mallet; they are then placed for 10 
or 12 hours in a solution of permanganate of potash i to 1,000, are 
well washed with sterilized water, and are placed in a strong phen- 
icated solution, where they remain a month or six weeks before 
being used. Then they are washed with boiled water, to remove 
the excess of phenic acid soaked into them. 

To-day sponges are generally discarded : they are replaced by 
compresses oi gauze and the sponge-tissue sterilized in the autoclave, 
or by halls ^oi hydrophilous wadding or peat wadding, also sterilized. 
Many veterinarians are still using oakuvi ; it is good only when free 
from the hard substances it contains, and sterilized by heat or im- 
mersion in an antiseptic solution heated to 100*^. Generally it is 
only soaked for five minutes in boiling water or in a solution of soda. 
Eloire uses the dry heat of an ordinary oven (oven for roasting) that 
is found in almost all houses ; the oven is filled with oakum, which 
is heated and removed when it begins to burn. 

Sterilization of silk thread is made by immersion for half an hour 
in boiling water or by keeping in the autoclave at los'^ to iio'^. Im- 
mersion for fifteen minutes in a strong phenic solution is sufficient. 
It is kept in phenic acid solution at 5 to 100, or in corrosive subli- 
mate I to 1,000. 

After removing the grease of catgut with ether, the threads are left 
to dry, rolled afterwards on spools, sterilized in dry heat, and pre- 
served in a strong antiseptic solution of phenic acid or corrosive 
sublimate, or in boiled olive oil. 

Silk-worm gut, also freed from grease with ether, is left for half 
an hour in boiling water and kept in glass tubes filled with a corrosive 
sublimate solution 2 to 1,000. 

Paraffined thread is prepared by dipping into melted paraffin linen 
thread which has been soaked in ether or spirits of turpentine (Pecus). 
Since it is a little rough when it has cooled, it is made smooth by 
polishing with a fine cloth. This thread is supple, does not absorb- 
organic liquids, and cuts the tissues but little. It is especially useful 
for sutures which are to remain long in position. 

Red rubber drain tubes are preferable to all others. After being 
washed in a concentrated solution of permanganate of potash, they- 



62 VETERINARY SURGICAL THERAPEUTICS. 

are left for 20 minutes in boiling- water, and then placed in glass 
tubes containing a corrosive sublimated solution 2 to 1,000, and ster- 
ilized by exposure to a temperature of 120*^ for half an hour. 

These manipulations, prescribed for the sterilization of compresses, 
threads and drains, are not strictly necessary. Immersion for 5 or 
10 minutes in a phenic, cresylic or strong corrosive sublimate solu- 
tion, carried to ebullition, is the common practice in veterinary 
surgery. It is considered sufficient (Bang). 

The operative field and its surroundings must be carefully purified. 
In all animals, the skin, even in a state of perfect cleanliness, is 
occupied on its surface by numerous micro-organisms of very many 
kinds, among which the staphylococci (staphylococcus albus and 
aureus) are especially abundant. It is, therefore, always indispen- 
sable to proceed to the disinfection of the region to be operated upon. 
If the skin is sound, the hair should be cut with scissors and the 
tegument soaped, shaved, brushed and washed with boiled water. 
After having been dried with sterilized compresses, friction with 
alcohol or ether should be made to remove the greasy substances on 
its surface. This is completed by a last washing with a strong 
phenic acid solution or corrosive sublimate i to 1,000. If the skin 
is infected, if the region is the seat of an ulcer, suppurating trauma- 
tism or a fistula, one must, the day before the operation, or several 
days before, scrape the wound with the curette, and then proceed 
as indicated. These two methods are not applicable to all surfaces. 
They must be modified for certain regions ; for the mouth, the nose, 
the ear, vagina, uterus, bladder, rectum and the foot. The surgery 
of those regions requires a special technic. In the case of all 
mucous membranes, in order to permit the more complete action of 
antiseptic solutions, a free washing with boiled watershould be made, 
to remove the mucus deposited on their surface. 

The mouth is a cavity always inhabited by micro-organisms, and its 
disinfection is difficult. In large animals, free washings with water, 
and cleansing with solutions of boric acid (2 to 4 per cent. ), of perman- 
ganate of potash (i percent.), are sufficient. In the case of dogs, loose 
teeth and diseased roots should be extracted. Gums are to be 
touched with a tincture of iodine or solution of creosote. 

Intestinal antisepsis, employed in cases where the intestines are to 
be the seat of the operation, or when manipulations are to be made 
in the peritoneal cavity (laparotomy, ovariotomy, cryptorchidy), de- 
mands the following precautions : purgation, low diet or milk diet, 
and administration of antiseptic agents. Saline purgatives given in 
small doses for several days do well to prepare the asepsis of the in- 
testines ; afterwards, naphthol, betol, or creolin (50 centigrammes 
io I gramme for small anihials, 5 to 10 grammes for horses and cat- 
tle). Enemas of solutions of permanganate of potash (i per cent.), of 



TECHNIC OF ANTISEPSY AND ASEPSY 63 

cresol (i to 2 per cent. ), corrosive sublimate (i to 200), or of boric acid 
(4 per cent. ), complete the antisepsis previous to the operation. Dur- 
ing intestinal diaeresis, the parts taken out of the abdomen should be 
spread upon warm sterilized compresses ; the peritoneum should be 
kept free from any matter that may escape from the incision ; the 
intestines should not be returned to the abdomen without perfect 
closing of the wound, and not until after the serous membrane, round 
the stitched parts, has been touched with a strong phenic acid solu- 
tion, so as to give rise to slight adhesive inflammation. After the 
operation, for eight or ten days, the patient should receive only liquid 
food in small quantities (milk and bouillon for small animals, milk 
and hay tea for the others) ; the animal should receive its ordinary 
rations by degrees. 

Rectal asepsis. — For this a low diet should be taken for several days, 
and the same agents as those used for intestinal asepsis should be em- 
ployed, especially the rectal irrigations. Disinfection of the anus is 
accomplished as in the case of the healthy, sound skin. 

Nasal cavities are rendered aseptic by washes and with sterilized 
tepid water, followed by solutions of corrosive sublimate, i to 5,000, 
or of permanganate of potash, i to 1,000. 

The eye is an organ requiring delicate asepsis. It may be washed 
with sterilized water, a boric solution, 4 per cent., cresol, i to 150- 
200, or the following, recommended by Panas, for man : 

Bi-iodide of mercury 5 to lo centigrammes. 

Absolute alcohol 20 grammes. 

Boiled filtered water 1,000 grammes. 

Corrosive sublimate must be used only in very weak solutions (i to 
5,000). Instruments must be sterilized, especially if the operation is 
to be on the eyeball itself. 

The disinfection of the auditory canal is made with weak antisep- 
tic solutions. The skin is cleansed with tepid water and soap ; after 
it is well dried, injections are made of boric acid (3 to 4 per cent.), of 
permanganate of potash (i to 1,000), or corrosive sublimate (i to 
5.000). If the secretion is abundant, it is advantageous to use pow- 
ders of bismuth, iodoform, salol, or dermatol. 

Antisepsis of the vagina is easy in most cases. First a soap wash- 
ing of the mucous is made ; then it is thoroughly irrigated with a 
boric (4 per cent.), cresyl (2 per cent.), or corrosive sublimate solution 
(i to 2,000). These irrigations are repeated for several days. Instead 
of a syringe, it is better to use an irrigator like that recommended 
for women by Tarnier, consisting of a glass reservoir with an India 
rubber tube, the extremity of which is introduced into the vagina. 
Vaginal disinfection is difficult when the mucous membrane is the 
seat of polypuses, ulcerated tumors, and in cases where it has been 
contaminated by the putrified afterbirth. 



64 VETERINARY SURGICAL THERAPEUTICS. 

Asepsis of the uterus demands the same measures as that of the 
vag-ina. With an India rubber tube, the uterine cavity is washed 
with tepid irrigations of a harmless antiseptic sokition (boric acid 
or cresol). Corrosive sublimate (i to 3,000), or bi-iodide of mercury 
(i to 20,000) can be used. 

With the exception of catheterism, but few operations are per- 
formed upon the bladder. In this case what is important is prophy- 
lactic asepsis. The dangers likely to follow urethral catheterism, as 
practised to-day, have been hitherto entirely overlooked. Acute 
cystitis and its numerous complications may be the consequence of 
the introduction into the bladder of dirty catheters, which are never 
cleaned, and are, therefore, more or less septic. Urethral probes 
should be disinfected by a long immersion in a strong antiseptic so- 
lution, and should be kept in special cases. 

In operations on the foot, local antisepsis may be obtained as fol- 
lows : The shoe having been taken off, the plantar surface is thor- 
oughly cleansed, the hair is cut short upon the entire phalangeal 
region, the hoof and the skin are thoroughly washed with soap and 
warm water, then with an antiseptic solution, in which they are 
soaked for fifteen or twenty minutes, and finally the feet are covered 
with moist antiseptic compresses, wrapped in a cloth and secured by 
bands of gauze. A cataplasm of linseed softens the hoof and may 
be useful, providing it is prepared with a somewhat concentrated 
antiseptic solution ; but for asepsis, compresses are undoubtedly bet- 
ter. (Benjamin.) 

Before beginning the operation the threads for ligatures and for the 
sutures and the dressing materials should be placed in one bowl or 
on a plate, while in others, containing the antiseptic solution, should 
be kept the instruments with absorbing cotton to take up the blood. 

As soon as the skin is cut the blood oozes out, and its flow in- 
creases as the cut is increased ; the field of operation is covered with 
it. As long as the hemorrhage takes place, extending through the 
small blood vessels, the blood should be taken up by the wadding of 
cotton balls, which are taken out of the antiseptic solution as they 
are needed. Irrigations with a strong phenic acid solution stimulate 
hemostasis, the tissues shrink, the vascular openings contract ; but 
these irrigations have the objection of producing a superficial ne- 
crosis. Unless infection exists, simple boiled or slightly salted water 
is sufficient. When small arteries, or veins of some size, are cut 
through, they are closed with the forceps or ligated with silk or cat- 
gut. In most inflamed tissues an abundant hemorrhage follows, 
even if there are no large blood vessels. In these cases thermo- 
cautery is advantageous ; the blade, heated red hot and passed over 
tlie edge of the wound, is sufficient to stop the hemorrhage. The scab 
formed is very thin and aseptic, and does not interfere with cicatriza- 



TECHXIC OF ANTISEPSY AND ASEPSY. 65 

tion by first intention ; in fact, it may be entirely absorbed. Such is 
the case also of ligatures left in the wounds ; they are digested by 
the tissues, destroyed in a few* days by the migratory cells and by 
newly formed elements (catgut), or are encysted and slowly ab- 
sorbed' (silk). 

If immediate reunion be looked for, every care necessary to prevent 
the wound from being contaminated should be resorted to. Perfect 
hemostasis and an exact closing of the wound are two essential 
conditions. A thin bloody aseptic layer, interposed between the 
edges, does not prevent primitive union ; tissues support it and in fact 
utilize it for the process of repair ; but large clots are absorbed with 
difficulty and form a ground most favorable to the multiplication of 
pyogenic microbes. Raw surfaces, dried as completely as possible, 
and covered with antiseptic vaseline (vaseline 50, pulverized boric 
acid 5, iodoform i), are to be brought close together throughout 
their whole extent, in their superficial and their deep part ; the 
contact must be uniforvi and entire. When the contact does not 
exist in the depth of the wound, a dead space is left, where the 
blood and the serosity gather, an " antiplastic" center, where the 
germs which may remain in it will rapidly multiply. In cases 
where the wound involves several layers of tissues, it is necessary, 
in order to keep them close together, to add to the silk or silk-worm 
gut stitches on the surface, some catgut or silk sutures lower down, 
held at their extremities by small rolls of gauze (quilled suture). 
Washing the suture with corrosive sublimate, drying it with wadding, 
and covering it with iodoform collodion or a cotton dressing, com- 
pletes the operation. 

In wounds, where the perfect adaptation of the edges is not pos- 
sible, or in traumatism with loss of substance, one must provide for 
the escape of the secretions of the wound by drainage obtained 
either with one or with several rubber tubes (tubular drainage), or 
with disinfected horse hair or silk-worm gut (capillary drainage), or 
again with gauze (draining tent). Rubber drain tubes are mostly 
used. They are secured to the lips of the wounds with thread, silk, 
or hair. They allow antiseptic injection without interfering with 
the sutures. 

Such are the measures required by asepsis and antisepsis, in order 
to give subjects operated upon, as nearly as can be, absolute protec- 
tion against infection. And many are the superfluous details which 
we have omitted. 

In most hospitals for human patients, a perfect appliance of special 
apparatus for disinfection, and of numberless precautions, insure, 
for a certainty, the success of the operation ; the surgeon can always 
obtain, when he wants it, reunion by first intention, and render 
harmless the long manipulations he has to make in the abdominal 
5 



66 VETERINARY SURGICAL THERAPEUTICS. 

cavity. Almost all the Veterinary Schools of Europe and of the 
New World have also rooms for operations, provided with appliances 
and material which make easy the practice of asepsis and antisepsis : 
such as the Daviauand Vinsot apparatus, — mattress for casting large 
animals ; special tables with metallic cover for other animals, the 
Chamberland autoclave, drying ovens, fixed and movable reservoirs 
for antiseptic mixtures, etc. 

Fortunately, it is not necessary to follow strictly this technic, 
in order to have, in the case of all kinds of animals, long lists of suc- 
cessful operations, without excepting those that are performed on the 
abdomen. Even in the case of man, when the operation is to be 
made outside of the hospitals, the surgeon, with less complicated 
means, knows how to realize a sufficient antisepsis and obtain an 
"almost complete immunity.*' 

Our colleagues, who have given lists of loo castrations on cryp.tor- 
chids, without a single failure, have certainly not complied with all 
these rules of antisepsis. Although these are very important, when 
one operates in an infected center, in the atmosphere of an hospital, 
with instruments "to do everything" (a tout fair'e), they may be 
partly neglected for operations performed under more favorable cir- 
cumstances, either in cities or in the country. Without such abun- 
dance of instruments, of vases, antiseptic agents and materials for 
dressings, conditions of asepsis can be realized, sufficient to insure 
satisfactory results in operation. There are, besides, circumstances 
in which a surgical interference must be immediate, in which the 
patient cannot be saved except by an operation made immediately, 
and that, too, with whatever means one may have at his command. 

In such cases, let us see how to proceed : The operation should 
be performed under a shed or in the open air, without neglecting to 
utilize the "sterilizing action of the sun." One should see that dust 
raised by the struggles of the animal be not permitted to accumulate 
in large quantities over the field of operation ; to do this a light 
sprinkling of the bed is an excellent precaution (Moller.) Two large 
basins should be used to prepare a solution of common salt (6 to 7 per 
cent) in boiled water. The region to be operated upon, clipped or 
shaved, should be well scrubbed with soap or with a rough towel, 
then washed with the salted water. After cleaning his nails, the 
surgeon should wash his hands and forearms with the same solution 
and soap. An earthen bowl passed through the flame of the alcohol 
lamp should be used for the ablutions during the operation. 

The instruments should be disinfected by passing them through 
the flame of an alcohol lamp, or a wax candle, or that of a straw 
fire, etc., or by dipping them for 5 or 10 minutes in a boiling solution 
of carbonate of soda (i per cent.) Boiling salt water will be used to 
disinfect the towels, threads, oakum, etc. 



TECHNIC OF ANTISEPSY AND ASEPSY. 6"; 

The wound to be operated upon must be protected by a dressing. 
It should be covered with layers of wadding- or oakum, arranged as 
the case demands, and secured with bands. For operations upon 
the foot, the general wrapping that we have been using for about lo 
years is far superior to the ancient "pads" supported by patholo- 
gical shoes made ad hoc. 

Dressings applied to the superior regions of the extremities should 
be moderately tight, or cover the entire part situated below the seat 
of the lesion, so as to avoid gangrene and the arrest of the circulation. 

The first dressing is very important ; often it decides the progress 
of the wound. It should be left in position a variable length of 
time. If the general condition of the patient is good, the traumatic 
fever moderate, the hyperthermia little marked; and if, besides, the 
dressing remains dry, it should not be renewed under 12 or 15 
days in winter, 8 to 10 in summer. The band or gauze should be 
taken off and then the superficial layers of wadding in succession ; 
if under these the others adhere to the skin, they should be softened 
or detached with a tepid antiseptic liquid. If it be a foot dressing, 
the whole should then be soaked in a pail and the skin should be 
carefully cleansed with wadding or cotton. 

In the cases where immediate union has been obtained, in general, 
the wound is cicatrized when the first dressing is removed ; if it only 
be in good condition, a second dressing is put on with the same 
attentions as for the first. Mechanical interferences and stretchings 
■of the edges should be avoided ; if one or several drains are in the 
wound, they should be replaced after having been disinfected, or 
should be changed for others smaller. When the wound suppurates, 
the sutures should be cut, the drains taken out and free antiseptic 
irrigation should be made ; and to avoid injuries to the granulating 
surface and inoculations of a post-operative nature, at times a new 
dressing, with or without drainage, is applied ; at others the wound 
is left uncovered, protected only by antiseptic liquids and powders ; 
the latter absorb the secretions of the wounded surface, prevent the 
pullulation of germs and diminish the absorption of toxic products. 

Various modes of treatment present themselves when local com- 
])lications (abcesses, undermining, phlebitis, lymphangitis, necrosis, 
caries) have occurred. This is not the place to consider them. Let 
us say, however, that continued bathing in warm antiseptic solutions 
acts marvelously with the infected wounds of extremities, and that 
atomizing with the same solution is excellent for disinfecting anfrac- 
tuous parts of the regions where bathing is not possible. With 
wounds of a bad nature, exposed necrosis, or fistulae, one may utilize 
with advantage the steam atomizer of Championniere (fig. 33). 

Generally, in veterinary medicine, antisepsis must be simple and 
not costly ; but no matter what the expense may be, it must be 



68 



VETERINARY SURGICAL THERAPEUTICS. 



carried out in penetrating wounds of the thorax, of the abdomen-^ 
articulations, tendinous sheaths, tendinous lesions, or of the carti- 
lages or bones. What we must expect of it is to protect our patients, 
wounded or operated upon, against serious infectious complications 
of wounds ; but the unfavorable conditions under which we ordi- 
narily perform the operations, and the restlessness of most animals, 
render uncertain the cicatrization by first intention of wounds of 
operations. 




Fig- 33 —Lucas— Championniere's atomizer.— 5, boiler; //, spirit lamp ; Z*, vase containing the anti- 
septic liquid. 



And although it be not necessary to make use of asepsis and anti- 
sepsis as strictly in the country as in hospital centers, wherever one 
uses the bistoury they must not be entirely ignored, as in such 
cases the omission would be the more blameworthy the better the 
serious possible consequences are known. Everywhere to-day, as 
in days gone by, when we commit that error, the small incision in 
the skin is a door open to infection and to death. If Ave cannot com- 
ply with all the exigencies of antisepsis, at least we must observe its- 
great rules — operate with cleanliness, and do not injure the patients. 
That is the first precept of the art : Prinio non nocere. 



HEMOSTASIS. 69 

IV. 
HEMOSTASIS. 

To reduce to the minimum the hemorrhage that takes place durhig 
5111 operation, and to guard against that which may follow, are im- 
portant rules of general surgery. The red sheet formed by the 
blood flowing from the small divided tissues veils them and also 
the organs that the instrument must spare ; and although it obliges 
the operator to stop his work frequently, it has no serious conse- 
quences. On the contrary, arterial or venous hemorrhages may 
produce abundant waste of blood ; if they occur secondarily and are 
not promptly averted, often they are followed by death. They must 
be prevented or attended to in order to stop them definitively. Per- 
fect hemostasis is peculiarly important in the operations upon the 
abdominal organs ; if blood escapes in a great quantity in the peri- 
toneal cavity, the inflammation of the serous membrane is a compli- 
cation seriously to be looked for. And, generally, when blood 
accumulates on wounds after the closing of their edges or the appli- 
cation of a dressing, suppuration takes place, and the production of 
general disorders of an infectious nature is greatly assisted. 

I. Preventive or Pre-operatory Hemostasis. — It is used princi- 
pally for operations upon the extremities. In the case of animals, 
digital pressure, tourniquets, or compressors are seldom employed. 
Ligatures and the Esmarch process are the usual expedients. 

For horses, ordinarily, circular and total constriction of a leg is 
made with a loop of cord, placed round the fetlock or the coronet, 
and is twisted several times round the parts or submitted to a torsion 
made with a piece of wood acting as a tourniquet. The strong- 
pressure made upon the vessels, where the cord is applied, cuts off 
the circulation, and the hemorrhage soon stops. This ligature has 
another effect besides. The conductibility of the compressed nerves 
•is less free, the sensibility of the regions situated below the ligature 
is diminished, and the pain of the operation is thus much reduced. 

Striction with an India-rubber tube or band is less primitive and 
less brutal. Take a strong tube, 50 or 60 centimeters long, stretch 
it in rolling it round the leg above the knee or the hock, tie both 
ends together or secure them with a strong thread (fig. 34). Hemo- 
static India-rubber bands and tubes are made with a metallic hook 
and eye, by which they can be well secured in making the proper 
•compression. 

The method of Esmarch is advantageous, when, having to ampu- 
tate a leg (small animals), or to excise organs highly hyperaemic 
((prolapsed uterus), one wishes to operate on dry tissues. The in- 



70 



VETERINARY SURGICAL THERAPEUTICS. 



ventor made it known in 1873, under the name oi artificial iscliceniia. 
It consists in the use of an elastic band (plain or covered rubber), 
which is rolled round the leg or the mass to be removed, beginning- 
at its free end. The spirals of the band, touching or partly covering 
each other, must exercise upon the tissues a strong pressure, which 
pushes back by degrees the blood towards the trunk. 

When the blood has been pushed out of the parts which are to be 
excised, a strong India-rubber cord is tied below the band, which. 







Fig. 34.— Preventive hemostasia. Rubber ties applied above the knee and the hock. 



pressing upon the arteries, closes them, and, therefore, acts as a 
garrot. The band is then removed and the operation is performed 
below the cord without blood. In this process, two hemostatic 
means are used: the artificial ischaemia, obtained by the centripetal 
pushing of the blood, which is thus kept in for the organism ; and 
the striction, which keeps the tissues bloodless by preventing the 
flowing of the arterial blood, and thus insures a bloodless operation. 
When the part which is to be submitted to Esmarchizaiioii is the 
seat of a wound, more or less extensive, this must be covered with 
a coat of wadding or a compress, which is placed under the band. 

When the operation is terminated, the blood-vessels are ligated and 
the constricting rubber cord removed. Often then, if the stump has 
not been cauterized, through the small arterioles and numerous 
divided capillaries, an abundant hemorrhage spreads over it, which 
is due to a vasomotor paralysis, the effect of the prolonged com- 



HEMOSTASIS. 71 

pression. This hemorrhage is arrested with cauterization, cold irri- 
gations, phenicated lotion, or by a compressive dressing. 

In general practice, the Esmarch method is not rigorously applied. 
Often only the circular constriction is used. Generally speaking, it 
is better to use it when the tissues are seriously injured or infiltrated 
with pus or infectious liquids, which, crushed in by the compressors, 
might give rise to serious accidents ; but as the hemorrhage is some- 
times very abundant on account of the venous stasis, it may be re- 
duced by the application of a second constricting cord to the other 
end of the region to be operated upon. 

Mediate compression, with the fingers, of the principal arterial 
trunk, which distributes blood to the parts to be operated upon, is 
seldom used ; if it is employed, it must be kept up until complete 
hemostasis is definitely obtained. During the operation it can be 
suspended in cases where the ends of the divided arterioles are hard 
to find ; small spurts of blood then indicate their location. When 
the garrot has been used, it is sometimes useful for the same reason 
to diminish the constriction. 

A strict diet for twenty-four hours before an operation is also a 
means of reducing the hemorrhage during bloody operations. 

II. Hemostasis During and After the Operation. — Most of the 
processes mentioned above are only applicable to a limited number 
of regions ; and often, during the progress of an operation, the blood 
flows freely from numerous small divided blood-vessels, veins or 
arterioles. 

There is only a slight hemorrhage, or none at all, when one has 
recourse to the processes for bloodless exaeresis : actual cauteriza- 
tion, thermo-cautery, galvano-cautery, caustics, linear crushing, tear- 
ing, elastic ligature, etc. 

As an excellent means of hemostatic diaeresis, actual cautery is, 
also, often used to make punctures or remove tumors. It has been 
abandoned for the destruction of neoplasms, since it seldom gave 
good results : under the scar produced by the cauterization, the 
irritated tumor would grow again. The red-hot iron, worked like 
a bistoury, is still used to make some excisions. When carried to 
white heat, it cuts the blood vessels too rapidly, and their oblitera- 
tion is then incomplete ; if it is only dark red it cuts them, at the 
same ti'me stimulating the retraction of the coats of the vessels ; so 
that this heat is the proper one to obtain good hemostasis. Intro- 
duced into the tissues, the actual cautery soon cools off ; and its 
repeated application is necessary to divide a layer of tissue or excise 
a tumor. On that account, the thermo or galvano-cautery are better 
instruments ; with the zoocautery one can make punctures, deep 
incisions, and excisions, without hemorrhage. 

The ecraseur of Chassaignac, almost unused now by surgeons for 



72 



VETERINARY SURGICAL THERAPEUTICS. 



mankind, is of frequent use in veterinary practice. It squeezes, 
crushes, and divides soft tissues, somewhat like a saw. Mucous 
membranes, connective tissues, muscles, blood vessels, fibrous 
layers, and neoplasms give way to the progressive striction of the 
ecraseur, and are cut without hemorrhage, if the instrument is worked 
with the proper slowness. Its action is principally remarkable upon 
blood vessels : the middle and internal coats of the arteries are 

ruptured and retract upon them- 
selves, while the external coat 
stretches and closes the open mouth 
of the vessel. Too rapidly made, 
the division does not prevent hem- 
orrhage ; but if one acts slowly, if 
the cutting of the tissues is made by 
gradual shortening of the chain, every 
30 or 50 seconds of time, according 
to the degree of vascularity, there is 
scarcely any flow of blood. The 
pain, which is very great when the 
tissues are strongly compressed, sub- 
sides as soon as the division begins. 
In general, the wcnmd of such cut- 
ting cicatrizes a little more slowly 
than that made with the bistoury : 
the anatomic elements of the super- 
ficial layer undergo a process of 
necrosis. 

The process of tearing is princi- 
pally used in the removal of tumors 
well defined, with little adhesion to 
the surrounding tissues. The skin 
being incised, the neoplasm is is- 
olated either by digital pressures 
or tractions made with the hands, 
vi^hich separate the parts in tearing the connective tissue ; or by 
giving to the neoplasm movements of traction and of torsion ; or 
by combination of the two modes. Although /eizr/^jo- is advantage- 
ous in this, that it permits of saving the principal blood vessels and 
nerves, it is generally very painful in regions rich in nerve rami- 
fications ; it does not allow the complete removal of invading ne- 
oplasms, extending to the lymphatics, and leaves "roots for new 
growths, "which give rise to secondary tumors. 

Dull dissection, the enucleation of Percy, is made with the dull end 
of a directory or spatula. The directory is generally used, with 
which the connective tissue is torn and isolated without danger of 




Fig. 35.^Chassaignac's ecraseur. 



HEMOSTASIS. 73 

hemorrhage. This is an excellent process when one has to operate 
in regions of dangerous structure. It is especially used to isolate 
blood vessels (ligature of the jugular) and nerves (neurotomies). 
Wounds made by tearing and by enucleation behave as those made 
with the bistoury ; they cicatrize nearly as easily and as quickly as 
clean-cut sections. 

Scraping is made by removal with the drawing knife or the sharp 
curette. It permits the excision, with little hemorrhage, of the 
granulations and fungosities which line fistulous tracts and walls of 
suppurating cavities, and the scraping of carious bones. 

The various modes of ligature are frequently employed to obtain 
the mortification and elimination of tumors, and of organs, in part 
or in toio (vagina, uterus). The best of these is the elastic ligature. 

But these means of exseresis are useful only in a limited number 
of cases. It is the bistoury which is generally used ; and often it 
divides tissues in which preventive hemostasis could not have been 
realized. Then the blood flows, in a stream or by spurts, as the 
instrument divides small blood vessels or arterioles. 

Capillary hemorrhages ordinarily stop spontaneously ; the very 
small vessels are depressed by the retraction of the tissues, and 
their microscopic mouths are soon obliterated. If the hemorrhages 
continue in streams, they can be arrested by affusion of cold boiled 
water, made with aseptic sponges or compresses, held up above the 
wound, and gradually squeezed. More active are the lotions with 
solution of alcohol, phenic acid or corrosive sublimate, which pro- 
duce a peculiar "pickling" of the living surfaces, coagulate the 
liquids, and, in general, rapidly correct capillary exudations. A 
strong phenic acid solution is the most advantageous. Not to be 
disturbed by these flows of blood, one must be careful to have pre- 
pared lots of little balls of cotton which have been dipped in an 
antiseptic solution. An assistant using these successively, after 
having squeezed them to rid them of the solution, should soak up 
the blood, dry the surfaces, and thus allow the surgeon to see clearly 
the parts upon which he is operating. Among the hemostatics of 
old surgery now out of fashion we may mention : snow, ice, ether, 
chloroform, alum, metallic sulphates, perchloride of iron, nitrate of 
silver, vinegar, Rabel solution, the numerous " hemostatic washes," 
the absorbing powders, — flour, ashes, agarics, amadou, and the 
dangerous spider web. 

When arterioles, small veins or canals of larger caliber are divided, 
one can arrest the blood by using compression or plugging, cauteri- 
zation, ligature, torsion, or " yorcipressure." 

Compression is useful in cases where one has no time to look for 
the end of the cut vessel. It is performed, as aforesaid, in tlie 
neighborhood of wounds or upon one of its lips, by pressing with 



74 VETERINARY SURGICAL THERAPEUTICS. 

the finger or a ball of cotton the part where the blood vessel is 
situated. It is rarely sufficient to produce definitive hemostasis. 
When the operation is ended, other hemostatic means must be used. 

Cauterization of raw surfaces and of vascular stumps is hemostatic 
only by making a more or less thick scab, great inflammation, and 
abundant suppuration. 

Ligating of Blood Vessels is made with silk threads or catgut. In 
excisions, when a visible and isolated artery has to be divided, two 
ligatures are applied upon it, between which the cutis made. If the 
blood vessel — -artery or vein — is divided by accident, the ends are 
secured with forceps or a tenaculum and tied up with a straight 
knot. Constriction made upon an artery has the effect of dividing 
its middle and internal coats, which, curving inwards in retracting, 
close its mouth. The external wall shrinks, rests upon itself, and 
does not give way for several days later. When catgut is used, the 
ends of the ligature can be cut close to the knot ; with silk thread 
only one of the ends is cut close to it, the other is brought outside 
of the wound, to be pulled away with the rest of the thread when 
the division of the blood vessel is complete. Hemostatic forceps 
wnth broad jaws, conical or cylindro-conical, are very handy to 
make these vascular ligatures. It is to immediate ligature that one 
must give preference. In the cases where that is impracticable, 
where the ends of the vessel are concealed deeply in the tissues, and 
difficult to find, mediate ligature is resorted to. With a curved 
needle, a thread is passed round the blood vessel and the soft tissues 
surrounding it, and is secured with a straight knot. 

Torsion, recommended by Amussat and more recently by Tillaux, 
may take the place of ligature for arterioles and veins of small 
caliber. With forceps, the bleeding stumps are taken hold of, gently 
drawn out of the tissues and twisted. The illimiied torsion of 
English surgeons consists in twisting the blood vessels until they 
are torn apart. The effects are similar to those of the ligature, the 
external coat forming a kind of cap which covers the clot formed, 
and fixes it firmly. Ligature is surer than torsion ; in arterioles of 
some caliber, the cellular coat may untwist and a secondary hemor- 
rhage follow. 

Th.e /orcipressure has distanced all other hemostatic processes. It 
consists in applying, upon the ends of the divided blood vessels, 
fixed forceps, which are left for a variable length of time, either 
until the blood vessel is closed by a clot, or only until the end of 
the operation, when permanent hemostasis will be realized by the 
ligature. 

Recommended by Koeberle and Pean, multiple forcipressure is 
now used everywhere, as a means of temporary or permanent 
hemostasis. Among excellent forceps recommended, those of Collin 



HEMOSTASIS. 



/5 



are best and strongest (fig. 36). Their jaws are conical and dentated. 
When, during an operation, the blood suddenly escapes from the 
mouths of a divided artery, an assistant takes hold of them with the 
forceps, and keeps them off the field of the action of the bistoury. 
With these forceps, dia-resis upon vascular structures can be made 
without arrests and without noticeable escape of blood. They can 
be applied in various numbers, as they are required ; all are left in 
place until the end of the operation ; they are pressed upon the small 
arteries for a few minutes only, and when they are taken off the 
hemorrhage has stopped. If large vessels have been divided, their 
ligature can be readily made. At times the forceps are left long 



/I 





Fig. 36.— Forceps. 

enough to produce a permanent hemostasis ; when, for instance, 
they have been applied upon deeply situated blood vessels, difficult 
to isolate and ligate. They are then fixed between the various 
pieces of the dressing or between the lips of the wound. They are 
removed after 24 or 48 hours, according to the size of the blood 
vessels they served to obliterate. 

The necessary forceps, threads, and all objects used, must be 
made antiseptic, an indispensable condition to obtain cicatrization by 
first intention, or if one wishes to avoid accidents by infection. 

For wounds of cavities whose walls bleed abundantly, phtgging 
with lodo/ormed gauze is also a good way to obtain hemostasis after 
an operation. 



76 VETERINARY SURGICAL THERAPEUTICS. 

Elaslic ligature is an excellent means of hemostatic exeresis. Used 
"first in human surgery (Dittel, Grandesso Silvestre), it was afterward 
tried in veterinary by Guerin, Rossig-nol, Nocard, Cagny, who have 
studied its principles and modus operandi. If it be applied to a 
certain thickness of living tissues, the stretched India-rubber cord 
acts in a constant manner, as long as it has not returned to its 
primitive dimensions ; in proportion as the tissues are divided, the 
loop diminishes in diameter and produces its dieretic action upon 
the deep layers. This is a great advantage over the simple ligature, 
whose brutal, immediate action becomes weaker quickly and is ex- 
hausted when reaching large peduncles. As soon as the superficial 
layers are divided, the cord acts only as a foreign body ; to com- 
plete the ablation, it is often necessary to apply a second ligature or 
to tie up the first. 

The elastic loop is without action upon inert bodies, even the less 
resisting, or upon dead substances, but it rapidly divides the Hying 
ones ; skin, muscles, blood vessels, tendons, and bones. Nothing 
resists it, and the diaeresis is made without hemorrhage ; the walls of 
the blood vessels collapse before they are divided, and this cavity 
is obliterated by thrombosis. Cicatrization is quick ; and often the 
wound is relatively small. Its uses are numerous : its application 
, is simple. A vulcanized tubular, or firm, cylindrical, or prismatic 
cord, of a size proportioned to the mass to be divided, is used. An 
assistant holds one end, the operator seizes the other, stretches the 
cord, rolls it round the peduncle ; three or four times are sufficient ; 
and, to fasten both ends, crosses them, passes them to an assistant, 
and passing an ordinary thread under their crossing, fastens them 
well together with a straight knot. 

For the extirpation of tumors, when the neoplastic mass has a well 
defined peduncle, the application of the elastic loop is easy. When 
the tumor is wide and not well defined, it is proper to pierce it through 
with one or two metallic needles to secure the fixity of the ligature. 
Rossignol has succeeded in obtaining in fifteen days the slough of a 
tumor from the shoulder, having a diameter of 20 centimeters and 
weighing t6 pounds; and in twelve days, that of a growth of the 
hock weighing 3 kilog. Other analogous facts have been recorded. 

Since the experiments of Rossignol and Cagny, the castration of lambs 
with elastic ligature is much practised. 2000 animals, 2 and 3 months old, 
were castrated, during warm weather, by Rossignol, with only 3 cases of 
tjtanus. This process is evidently superior to " tearing." It is also good 
for cattle.* In Egypt, in 1885, Piot operated upon nearly 2,oco bulls and 
buffaloes, without an accident or complication of any kind. Disinfection of 
the scrotal region, soaking of the cord in the Van Swieten solution; after- 
wards, antiseptic washes, after six or eight days cutting away of the morti- 

* We have successfully castrated two llamas belonging to the Zoological Garden of New York, and 
4hree camels of the famous Barnum & Bailey Menagerie, with the use of the elastic ligature. (T.) 



CAUTERIZATION— FIRING. 7/ 

fied tissues, and application on the stump of a coat of tar, previouslv 
submitted to boiling; such are the precautions to be observed. 
Generally, those operated upon can resume their work towards the 
fifteenth or twentieth day. 

Elastic ligature has . been tried for the castration of solipeds. 
Applied upon the exposed spermatic cord, as in the uncovered 
process, the rubber ligature amputates the testicle in two ox three 
days. But serious complications (tetanus, septicaemia, peritonitis) 
have been so common, that this mode of castration has been rejected 
in ordinary practice. In 1880, out of 20 castrations, Tapon had 
5 deaths. Pinel says, he was more fortunate in tying the ends of 
the rubber with a piece of twine. In this way, the spermatic cords 
can no longer be drawn vip into the inguinal canals, so rich in con- 
nective tissue, and on that account so easily inoculated. Using an- 
tiseptic measures, this veterinarian had only one serious accident 
out of 400 operations. The application of the rubber cord over the 
skin, is followed by the slough of the testicle in 3 or 4 days ; but 
there is a large wound remaining (Cagny). 

Elastic ligature has other uses. When, in prolapsus of the uterus, 
the organ cannot be reduced, or is the seat of extensive lesion, a 
strong rubber ligature can be applied at its base, the organ amputated 
below it, the stump thoroughly disinfected and then returned into 
position. All hemorrhage can be prevented by the application of 
the Esmarch bandage before the prolapsed uterus is amputated. 

Cagny has recommended elastic ligature for the amputation of the 
tail of a horse. The most painful part of this operation is not the 
section of the tissues, but the cauterization ; and in certain breeds 
of horses, the application of the red hot iron gives rise to violent re- 
actions. One may avoid the cauterization by placing, before the 
amputation, an India-rubber ring immediately above the place where 
it is to be made. Some say it must be left on for eight days, but it 
may be taken off after 24 or 48 hours. Its use in our hands for removal of 
large cap. elbow, has not given us good results, on account of the large 
wound left after the sloughing of the growth, which in one case required no 
less than three months before complete cicatrization occurred. Elastic 
ligature has also been used to obtain temporary hemostasis in bloody 
operations upon the extremities. 

V. 
CAUTERIZATION— FIRING. 

We shall not stop for the consideration of cauterization with chemical 
agents. This was much practised in former times to slough altered struc- 
tures or to destroy neoplasms; to-day it is almost abandoned. It is a long, 
painful process, and is not even good f )r most tumors; under their super- 
ficial layers when destroyed, the irritated neoplasm grows, granulates, and 



Ti 



VETERINARY SURGICAL THERAPEUTICS. 



spreads. A few cutaneous benign tumors, rebel ulcers and "canker" of 
the foot represent about the only actual calls for its use. 

From the beg-inning- of the art, at Cuidus and at Cos, actual 
cauterization was believed to be the most energetic therapeutic 
agent. Hippocrates thus spoke of it in one of his aphorisms : 
"What drugs do not cure, fire will ; what is not cured by fire can 
be looked upon as incurable.'' ' After having been used largd manu, 
cauterization was ignored for many centuries. Solleysel rehabilitated 
it for our patients, and laid down its first rules in his '' Par fait 
MareschaV (1664.) "To well apply firing, three things must be 
observed : ist, That the one who applies operate with light hand, and 
does not press too heavily upon the skin with the iron knife ; 2d, that 
the instruments be only at a red and not a white heat ; 3d, that 

they be heated only with charcoal I have had firing 

applied hundreds of times in many places with great success ; 

horses have always been benefited by it It is of great 

importance to prevent the horses from scratching, rubbing, biting or 
licking the cauterized parts, since no matter how well the operation 
has been performed, if these precautions are not taken, the parts will 

be deformed In firing, unless it is absolutely necessary, 

and then never in other than the necessary places, should the skin 
be cut ; it should be cauterized by degrees without hurry, until it 
has taken a sherry color. . . . Time is necessary to fire well ; 
and it gives better results if the firing is done with irons moderately 
hot, passed five or six times in the same line, than with very hot 
irons which cut through at once or burn only the hair, as blacksmiths 

do When firing is finished, one may spread over the 

cauterized parts a layer of lard or of yellow wax, melted and mixed 
with melted black pitch ; after nine, ten, or twelve days, all is 

washed every day with alcohol Every one has his way 

of firing ; some make use of silver knives, others of brass or copper 
irons : copper I prefer, as this metal is very good for wounds. 

The effects of firing are slow ; I have seen animals in which 
the effects of firing were not fully realized for six months ; it is an 
imperceptible resolution ; time is required to produce the absorption 
and reduction looked for .The effect of fire lasts twenty- 
seven days, nine for its increase, nine for its developed condition 
and nine for its subsidence ; the least time that ought to be given 
for one to see the good effects is eighteen days Twenty- 
five years ago, to speak of firing a horse or to send it to the skinner 
were the same thing ; to-day it is different ; I have removed the 
fear that people had of it ; experience had conquered." 

In his '' Nouveau Par/ait MareschaV (1741)' Garsault reproduces 
the same principles, and recommends firing, "following as closely 

' CoUcctioH hippocratiqtte, trad, of Littr^, vol. iv., Aphorisms, p. 609. 



CAUTERIZATION — FIRING. 79 

as possible the direction of the hairs, so that when they grow out 
again they may cover the marks." He advocates, also, firing as 
a preventive, as practised in Oriental countries. "The only reason 
preventive firing is not done in this country, as it is in others, is 
because of the scars, which will lessen the value if the animal is 
offered for sale ; but if one wishes to keep his horse, firing of the 
legs will do it good. " 

The hippiatres of recent times have abused firing. Having 
but vague and incomplete notions about anatomy, they preferred it 
as a means of hemostasis. Although its use has been greatly 
restricted during this century, it remains yet in veterinary surgery 
a therapeutic method well established and daily used with success 
against numerous affections which have not yielded to other modes 
of treatment. No doubt it is painful, it imposes long rest, and at 
times leaves permanent marks ; but compared with the advantages 
it offers, these objections are of little importance. 

Among the uses of actual cauterization, the most common are for 
chronic affections of tendinous sheaths, of bones and of joints ; 
synovitis, hydarthrosis, sprains, luxations, exostosis, periostosis, ex- 
tensive callosities, caries, and necrosis. It is the most generally used 
curative agent for some tendinous lesions, amyotrophia, chronic in- 
flammatory alterations of the connective tissue, and for various 
kinds of cysts. It is used also ordinarily for treating the old lymph- 
angitic and phlebitic indurations, fistulae, refractory ulcers, summer 
and virulent wounds, anthrax tumors, septic swellings. 

There are two kinds of cauterization, the superficial ^XiA the deep, 
each of which is applied by various methods. Cauterization in sheet 
is not practiced ; and the ignited substances, the moxas, are no 
longer used. As much can be said oi cauterization by radiation, or of 
the method with warm liquids and of mediate cauterization. 

The only processes used to-day are : 

1. Superficial cauterization, in points or in lines, in which the 
instrument does not penetrate deeper than the dermis. 

2. Catiterization with fine penetrating points, in which the skin is 
perforated through and through with one or several strokes of the 
cautery. 

3. Needle cauterization, in which the instrument penetrates into 
muscles, tendons, ligaments, bones and synovial sacs. 

4. Subcutaneous Cauterization, done after incision of the skin. 

CAUTERIZATION OF SOLIPEDS. 

Yo\ firing in lines, instruments having the shape of a triangular 
prism are used. (Fig- 37-) They are of small size for thin skinned 
animals ; they are larger for those whose teguments are thick. The 



8o 



VETERINARY SURGICAL THERArEUTICS. 



cauterizing; edge must be slightly convex, blunt throughout its 
whole extent, rounded at its angles ; and its rod would better be 
moderately rounded in. With such instruments the uneven parts 
of the region can be well followed, and the heat evenly distributed. 
The active part oi point cautery (fig. 37) is disposed in a conical form 

more or less elongated ; it 
varies in size. For penetrat- 
ing or deep pointed firing, a 
cautery more elongated than 
the preceding is used. Abadie 
has recommended an instru- 
ment with which he could 
run through the subcutaneous 
connective tissue and deep 
into the tissues. When one 
does not wish to go beyond 
the subcutaneous connective 
tissue, ordinary cauteries 
more or less elongated an- 
swer all purposes. Needle 
Cauterization requires very fine 
needles which can penetrate 
all tissues. At first iron need- 
les, 2 millimeters in diameter, 
and one or two decimeters 
long, were used ; heated to 
red heat, they were taken 
hold of with nippers and implanted in the tissues. Bianchi, Lenck, 
Foucher, have recommended cauteries having an olivary part, 
terminated by a point of iron or platinum. The most of those in- 
struments with a separate needle cool off too quickly and burn the 
skin round the perforation. To protect the skin, Watrin had a 
little disk of metal placed between the needle and the olivary part 
of the cautery. 

Bourguet (fig. 38), Vasselin, Hermann, andEhret have invented the 
first cauteries with movable needles and independent heating. 
That of Bourguet is superior to all others, and we use it often at 
Alfort, with best results. A screw (A) regulates the penetration of 
the needle, which is heated in the interior of the heat carrier, a 
slight pressure from downwards upwards upon the branch F pushes 
it out ; as soon as it is removed from the tissues, it is allowed to 
return to the heating mass, which is fixed by a spring (INI). A 
screen protects the skin. Notwithstanding its apparent complexity, 
this instrument is remarkable for its solidity and the regularity of its 
Working. 




F'g. 37 — Lines firing iron. Dots firing iron. 
Sharp pointed firing iron. 



CAUTERIZATION — FIRING. 



;i 



The Paquelin cautery (fig. 39) is based upon the property that 
platinum possesses, when once brought to a given temperature, of 
becoming incandescent in contact 
with a mixture of air and hydro- 
carbon vapors ; and of remaining 
in this condition as long as the 
contact may last. The cauteriz- 
ing part is screwed on a rod, and, 
according to needs, may be a point, 
a needle or a knife. The lighting 
is simple. The cauterizing part 
is heated Avith the alcoholic 
lamp ; after a few minutes the 
bellows is called into play. The 
platinum reddens at once. The 
ordinary Paquelin is rather weak 
for large animals. Often, if the 
animal reacts much, the point 
bends, or becomes loose, or the 
rods more or less deranged. 

The Zoocatiiery (fig. 40) is more 
solid and better adapted to our 
uses. Its construction rests upon 
the power of the platinum to 
remain incandescent under the 
action of the hydrocarbon aceous 
vapors, and upon its remarkable 
conductibility. The reservoir (A) 
contains a sponge moist with a 
small quantity of mineral essence; 
at one extremity is fitted a 
Richardson bellows ; on the other 
is screwed a peculiar branch, car- 
rying a cautery in point or in line, 
whose base is perforated with lat- 
eral holes, which permit it to act as 
a siphon. A tube inside carries 
the vapors of the essence to the 
point of platinum ; a screw (H) 
allows the essence to burn in the 
siphon, or prevents its reaching 
the siphon by the central tube. 

To make the instrument work, a small quantity of essence is 
poured upon the sponge, that which is in excess having been ex- 
pelled, the cautery is screwed on the reservoir, and the bellows 
6 




Fig. 38 — Bourguet's cautery. 



82 



VETERINARY SURGICAL THERAPEUTICS. 



adapted ; the screw H and the spigot B are now opened. The bellows 
are worked, the vapors of essence which escape by the lateral open- 
ings of the siphon are lighted, gradually the spigot B is closed until 




Fig. 39 — Paquelin's cautery. 



the flames do not come out any more. Soon the central tube red- 
dens ; and the siphon being then closed by the screw H, the point 
of the cautery is soon seen becoming red in its turn. As the 
quantity of essence diminishes in the sponge, to keep up a sufficient 
quantity of heat, the spigot B has to be opened gradually. 

This cautery is very handy ; it permits rapid application of firing 
in superficial deep points ; but though the needle is made of iridized 
platinum, it bends just like that of the Paquelin cautery. This has 



CAUTERIZATION — FIRING. 



83 



the more serious objection, however, that the assistant who has 
charge of the bellows soon becomes tired working it. 

In the cautery Paqiielin de Place (fig. 
41) the heat is also furnished by the 
combustion of hydrocarbon vapors. 
For needle firing, one full needle is 
made to pass through the heating 
chamber, and when it is heated, is 
brought out by pressure on the con- 
ducting rod; when cooled off, the press- 
ure is relieved and permits the needle 
to return into the heating chamber. 
Though not without advantages, this 
instrument is less handy to work with 
than the thermo or the zoocautery, 
and the cauterizing action of the hollow 
points of platinum is less active than 
that of solid points of iron or steel. 

To heat ordinary cauteries, a forge 
or a heating furnace is used. Wood 
coal or coke is preferable to other coal. 
An assistant watches the process of 
heating, and when the instrument 
has sufficient amount of heat, he takes 
hold of it, passes a file over its sharp 
part and gives it to the surgeon. 

Lagriffoul, Faugere, and Perrin 
have had the idea of using eoli- 





Lines cautery. 




Fine point cautery. 



\ 



Fig. 40 — Zoocautery ; A. tank ; B, cocfcj 
G, hollow stem ; E, fire point ; H, regu^. 
lating screw, . 



piles like that of Paquelin. These instruments are useful and keep 
the cauteries clean and free from clinkers. Some are dangerous. 
That of Lagriffoul (fig. 42) is fixed on a table which carries a kind 



84 



VETERINARY SURGICAL THERAPEUTICS. 



of chimney where the flames collect and where the cauteries are- 
held to be heated. The heating of the cauteries is done by the- 
burning- of some mineral essence poured into the lamp. The instru- 
ment will do its work from half an hour to two hours without refilling. 

Whatever is the mode of firing, some general rules are to be ob- 
served. If possible, a favorable time should be selected. Spring- 
and fall are favorable, and summer objectionable, as during that 
season the inflammation is often exaggerated and the itching intense^ 
the animals scratch, rub, and bite themselves, so that, at times^ 
serious accidents are the result. 







Fig_ 41— Paquelin de Place's cautery. 



The preparation of the animal is important. It should have 
fasted, if it is to be cast ; if very strong and plethoric, its rations- 
should be reduced for several days, and a laxative should be given. 
The region to be fired should be cleaned, all scabs brushed away, if 
there are any ; the hair should be clipped with the machine or cut 
short with the scissors. For superficial firing, the hair should be 
left a little long ; so that the instrument may be kept from sliding 
off the point or the line marked off, by a thin carbonized coat of 
burnt hair. For the deep cauterization of synovials, some antisep- 
tic measures may be useful. The cleaner the skin shall be, the less 
the danger of infection after the operation. When firing is applied 



CAUTERIZATION — FIRING. 



85 



lo regions where the skin is very loose, it is wise to mark the out- 
lines of the surface to be cauterized before the animal is thrown. 

Quiet, unirritable horses will endure the operation well, in the 
standing position ; a twitch on the upper lip and the foot raised are 
sufficient. Sometimes firing can be done in special regions, by 
putting the horse in stocks. 

But when firing is very painful, it is better to cast the animal. If 
Ihe operation is to be on the external surface of a leg, he is thrown 



cr::!^ 




Fi?. 1 




Fiff 2 



Fig. 42. — Eolipiles. 



on the opposite side ; if the firing is to be applied all round the 
joint, the inner surface should be operated upon first. When one 
fires, at one sitting, the legs diagonally opposite, the external face of 
one and the internal face of the other should be operated upon first ; 
and when the animal is turned for the second part of the operation, 
the cauterized surfaces must be protected from the bedding by cloth. 
The fastening of the animal varies with each particular case. Gen~ 
erally the leg to be operated upon is kept in the hobble ; its con- 
gener is fastened either forward or backward, as the case may be. 
When the coronet or fetlock is to be fired, the best way is to secure 
both legs together, above the knee or the hock, with a rope, passed 



86 VETERINARY SURGICAL THERAPEUTICS. 

in a figure 8 round both ; then to take the diseased leg out of the 
hobble, pulling it forw^ard or backward to operate upon. The 
hobble-stick is not necessary. 

Let us consider the technic of line cauterization. (Fig. 43.) 

When the subject is prepared and secured in good position, the 

operator marks the firing. Renault recommended that the lines 

should be parallel to the hair; Bouley, like Garsault, preferred 

them oblique. The transverse lines of the English are as good and 




Fig. 43. — Cauterization of the principal regions, where fire is generally applied. — Shank, fetlock, pastern 
and coronet of the left hind-limb: superficial point firing; — pastern and coronet of the left fore-limb i 
sharp point tiring ; — tendons and stifle of right limbs : stripe firing. 

do not disfigure any more. The drawing of the firing is of little 
importance. Fancy drawings have long been abandoned. What 
is essential, is to make the lines straight, evenly distant, and ex- 
tending somewhat beyond the diseased zone. Converging lines- 
must not come together nor cross each other, as the cutaneous 
portions of the angles would be exposed to too much heat and might 
slough. When the firing is to envelop a section of the leg, a verti- 
cal line should be drawn in front and behind, to indicate where the 
lines of the lateral fans are not to extend on the opposite face. 

The spaces to be left between the lines vary according to th& 



CAUTERIZATION — FIRING. 8/ 

thickness of the skin and the extent of the region to be cauterized. 
Closed and superficial lines are preferable to those made far apart and 
deep. Generally they are separated by one to one and a half centi- 
meters. Once marked, firing must be made with the proper degree 
of heat. The cauteries, heated to a dark red or bright red heat — 
ieniperatura maxima — should be slowly drawn over the lines, with- 
out pressure in lowering or raising the hand, according to the 
surface, — the instrument always held perpendicular to the skin. It 
should be drawn towards the operator or pushed away from him, 
but never contrary to the growth of the hair. It should not be passed 
twice in succession over the same line ; the firing should be carried 
the whole extent of the region, beginning at one end, passing suc- 
cessively to the other, and returning to the starting point. In this 
way, one may avoid the destroying effect of the heat. When the 
surface is small, one should proceed slowly and leave a little time 
between the applications of the instrument. 

What are the signs which indicate that the firing is sufficient .-' 

The aspect of the bottom of the lines, the exudation which takes 
place, the state of infiltration of the skin and the more or less 
marked rise of the epidermis, almost always tell exactly, providing 
the operation has been performed according to the established rules. 
There are three degrees of firing. According to the first, the lines, 
not deep, have a few drops of serosity oozing from their borders ; 
their bottom is slightly yellow ; the skin slightly infiltrated ; the 
epidermis still adherent. According to the second, the lines are 
deeper ; their bottom a clear yellow ; the oozing of serosity greater ; 
the epidermis is easily raised. According to the third, the skin is 
almost entirely cut through ; the edges of the lines have a tendency 
to separate widely and may leave ugly cicatrices ; their bottom is 
straw yellow, filled with abundant serosity ; often the skin is covered 
with little blisters. The cautery, heated to a bright red color, 
should be carried along each line five or six times for a light firing, 
eight or ten for an ordinary, from twelve to fifteen for a strong 
cauterization. These numbers, of course, will vary with the weight 
and the temperature of the instrument, the dexterity of the operator, 
and the condition of the skin. 

Superficial point cauterization may be performed in many regions 
standing. The points are placed in a quincunx. In general, points 
and lines are separated by the same space. They can be made closer 
at the places where the firing is to be more severe. 

The application of the points is repeated according to the intended 
strength of the firing. As in line-firing, the strength is recognized 
by the color of the skin at the bottom of the points, by the quantity 
of serosity thrown out, by the condition of the epidermis between 
the points. To apply the pointed cauteries once or twice only and 



88 VETERINARY SURGICAL THERAPEUTICS. 

cover the parts with a blister, is a process very advantageous when 
one desires to avoid disfigurement. 

To U. Leblanc is due the introduction, into our surgery, of 
catderizaiion in deep fine points, which he made known in 1836. The 
characteristic of this method is the piercing of the skin through to 
the subcutaneous connective tissue. The points are appHed in the' 
same way, but somewhat closer than in superficial firing. The 
instrument is slightly pressed upon, so that with one or two strokes 
the skin is perforated. 

The advantages of this mode of cauterization are facility and 
rapidity of execution, and more intense and deeper action. Leblanc 
used to run through the skin with two, three or four strokes of the 
instrument, and complete the operation with a blistering application. 
During summer, we apply the instrument only twice. When the 
cautery is applied three or four times, especially during the hot 
months of the year, it is prudent not to use the blistering process, 
until a few days after — if the firing is not sufficiently strong. 

For a long time, the absolute respect, in veterinary surgery, for 
synovial membrane, was dogmatic. It was known that happy 
results had been obtained by Basch, Boettger, Fischer, Robertson, 
and Bruche, with fine punctures of synovial sacs with the red iron or 
with the bistoury ; these practitioners were not imitated, their 
advice remained a dead letter : so many unsuccessful attempts were 
known, though they had not been published. 

In 1847, Rey had already observed'the harmlessness of the intro- 
duction of fine incandescent needles into the synovial membrane. 
Twenty years later, Bianchi made known his experiments of the 
Treatment of Synovial Dropsies with Heated Needles. The new method, 
studied and discussed by Abadie, Bouley, Foucher, Peuch, and 
Lenck, aroused much opposition at first. It has, however, resisted 
all attacks ; and the number of its advocates is daily increasing. 
When well performed, it is harmless, even for articular synovial 
membranes ; and for intensity of action, and therapeutic value, it 
surpasses all others. It is indispensable to use very fine points, the 
diameter of which does not exceed one millimeter and a half. In 
preference to the ordinary elongated cauteries, needles of uniform 
diameter should be used ; such as that of the Bourguet cautery, or 
the platinum point of the Zoocautery. 

The dots are arranged in a quincunx, one centimeter apart. The 
technic is somewhat important; the heated needle is implanted 
in the tissues to the desired depth and immediately taken out. When 
it is over the course of blood vessels and nerves, it should not go 
deeper than the subcutaneous connective tissue. There is no harm 
in insertins: the instrument several times in the same dot, when one 



CAUTERIZATION — FIRING. 89 

is operating on fibrous or bony tissues ; it is necessary to do so, if 
■one desires to produce a strong effect, though this is dangerous, even 
with fine needles, for synovial membranes. We have seen carpal 
synovitis follow an application made twice in the firing of a tendon. 
Dots made with the red iron are aseptic, and such they remain as 
deep as they go, when made small, fine, and with one stroke. It is 
not necessary, however, for synovial dropsies, that all points shall 
be perforating. 

Give a single stroke for synovial membranes and two or three for 
other tissues ; in some cases complete the operation with a blister ; 
such are the rules of the needle cauterization. 

Shall the cauterized regions be recovered with emollient applica- 
tions.'' The observations of Renault, Favre, Gourdon, and Peuch 
have shown that greasy substances assist suppuration, interfere with 
cicatrization, and increase the size of wounds and of cicatrices. 
Their immediate use after cauterization is condemned. When the 
inflammatory reaction is too severe, antiseptics may be resorted to 
(lotions or powders). If cauterization is not sufficient, a stimulating 
friction (a blister, mercurial or red precipitate ointment) must be 
made after the second or third day. Notwithstanding the absence 
of exudation in too strong firing, practitioners know how to distin- 
guish it from weak firing. 

The consecutive phenomena of firing vary rnuch, according to the 
method used. If the firing has been superficial, no matter in what 
shape, during the days following, the region is swollen, and an 
exudation more or less abundant is thrown out at the bottom of the 
dots or of the lines, which soon dries up and forms yellow grayish 
crusts, covering the entire region ; the resting of the leg is very 
painful, the lameness is apparent and a severe itching exists. As 
long as this lasts, the patient must be closely watched ; and to 
prevent his biting and rubbing himself, he has to be tied up close to 
his manger, with a cradle or a side bar fixed to his halter and 
surcingle. The crusts become loose towards the eighth, tenth or 
fifteenth day ; to accelerate their dropping, frequent lotions of warm 
water may be applied, in preference to poplar ointment ; if the skin 
has a tendency to crack, it may be covered with borated vaseline 
or glycerine. Later on, the eschars produced by the cautery drop 
off themselves ; when a great thickness of the dermis is involved, 
they som.etimes adhere longer, and their sloughing takes place bv a 
suppurative process, which leaves exuberant granulating surfaces, 
followed by permanent scars, no longer concealed by the new 
growth of hair. 

While these phenomena take place on the surface of the skin, the 



90 VETERINARY SURGICAL THERAPEUTICS. 

subcutaneous tissues are inflamed, and in a state of hyperaemia ; 
an abundant exudation infiltrates them, and an active cellular prolif- 
eration takes place in them ; followed by resorption, induration 
and compression, and ultimate and salutary effects of the caloric 
action. 

The effects of firing in deep points are more apparent than those 
of superficial cauterization. The swelling of the leg is often greater, 
although the serosity flows abundantly through the perforations 
of the skin. Applied in this manner, says Leblanc, "firing leaves 
as many cicatrices on the skin and in the cellular tissue as there 
have been dots made. Those cicatrices, numerous and very close 
together, produce a good effect ; they form a kind of permanent 
compressive bandage, far superior to any other." Indeed, it is 
certain that the retraction of these little islands of inodular tissue 
have, through the medium of the skin, an active compressive effect 
upon the diseased tissues, analogous to that which would be made 
with a solid elastic band. The care afterwards is the same in this 
as it is in superficial firing. 

The phenomena following needle-firing vary according to the 
depth of the punctures and the nature of the tissues involved. But 
there is always a great inflammation of the cauterized region, the 
leg becomes much swollen, at times very hot and painful, and the 
animal is affected with a more or less marked reactive fever. When 
the firing has been applied upon a synovial tumor, "besides the 
serosity, synovia flows, sometimes in large quantities, which forms, 
upon and below the cauterized surface, a grayish yellow albuminous 
coat, running down the leg to the ground, and sometimes soiling 
the bedding." 

After two or three days, this serosity dries up, the holes become 
obliterated, and the flow stops. The crusts fall off during the 
second week, the eschars are eliminated towards the twentieth day, 
leaving in their stead little rosy cicatrices. The swelling of the 
region lasts sometimes very long ; exercise and massage accelerate 
its decrease. The hair grows quickly and covers almost entirely the 
hairless spots of the cauterization. This is one of the great advan- 
tages of the method. 

Whatever is the degree of firing or the mode used, a certain length 
of time for rest must be allowed to the animal operated upon. 
Generally after 8 or lodays it may resume exercise, walking daily for 
20 or 30 minutes. A week or two later, it can resume work. A 
longer rest is advantageous, however, for tendinous lesions, some 
forms of spavin and other affections. 

Accidents of firing are common. The straight cautery may cut 
through the skin and give rise to a great separation between the 
lips of the line ; capillary hemorrhages and excoriations of the skin 



CAUTERIZATION— FIRING. 



91 




Fig. 44. — Subcutaneous cauterizing. (Lanzillotti Buonsanti.) 



are not uncommon. These are easily avoided by careful attention 
to the technic of the operation. 

JNIore serious are the sloughs of skin and defective cicatrization, 
which are the results of excessive cauterization. When firing is 
followed by very severe inflammation, so that sloughing is threatened, 

care must be immedi- 
ately taken to prevent 
it. A fine cold spray, 
repeated often, is one of 
the best methods to 
use ; it cleans the region 
and removes the irrita- 
ting exudation, which 
increases the inflam- 
matory phenomena. 
Astringent lotions and 
compresses (white 
lotion, alum water) have 
their advocates. Tepid 
antiseptic irrigation, the 
use of powders of io- 
doform, alone or mixed 
with tannin, are preferable. Nocard gives preference to atomization 
of iodoform ether : " They stop the itching and prevent the microbic 
infection of the wounds." Let us also mention, but proscribe 
entirely, the practice which some have of applying a blistering 
preparation to the inflamed surface. Hemorrhages following the 
puncture of a vein or artery with the heated needle are not danger- 
ous ; they stop of themselves, by pressure or the introduction of a 
small hemostatic, a piece of cotton. Other lesions, such as tendinous 
or cartilaginous quittors, arthritis, and synovitis, we have already 
shown how they are to be avoided. 

Subcutaneous cauterization, recommended for a long standing 
lameness of the shoulder or of the hip, has two principal steps. 
(Fig. 44.) 

1. Incisio?i a?id detachf?ient. — After the hair has been shaved over 
the region to be operated upon, a vertical incision is made, 8 or 10 
centimeters long. Both cutaneous edges are loosened from the 
tissues underneath for a certain distance, and then separated from 
each other with spreaders, after being covered, for protection, with 
a wet cloth. 

2. Application of firing. Upon the exposed parts, a certain number 
of points, superficial, or more or less deep, is applied, following the 
same rules as for ordinary modes of cauterization. For a superficial 



I 




92 VETERINARY SURGICAL THERAPEUTICS. 

firing, 5 or 6 applications of the points are sufficient. With the 
special buttoned cautery (fig. 45), Lanzilloti Buonsanti scarifies 

a thiri layer of tissue. 
Brambilia makes sev- 
eral small incisions 
through the skin and, 
in each of them, applies 
a firing point. 

The care afterwards 
is that required by all 

Fig. 45. — Bead firing irons. (Lanzillotti Buonsanti.) Sunnuntino- SlirflCPS 

Generally only a linear mark is left after the operation. At times, 
however, there is an irregular callous cicatrix. (Peuch. ) 

CAUTERIZATION OF BOVINES. 

Firing is used less for those animals than for horses. But the good 
results that may be obtained have been made familiar by the writ- 
ings of Cruzel, Roche-Lubin, Festal and Lafosse. 

The technique differs little from that followed for horses. The 
skin, thick and "rich in serosity," can longer endure without ac- 
cidents the application of the cautery. But the thickness of the 
dermis is very different according to the region ; it varies in the 
proportion of one to four. From this point of view, Bouley had 
made a progressive scale of the principal regions upon which opera- 
tions are generally performed : ist, Degree, Inguinal region ; 
2d, internal face of the hock, canon, and posterior face of the knee ; 
3d, point of the shoulder, and outside of the stifle ; 4th, external 
face of the hocks, fetlock, and coronets ; 5th, front, back, and 
loins; 6th, hip joint ; 7th, anterior face of the knee. 

Lafosse says : " It is necessary to submit the steer, before the 
operation, to a strict diet of at least 12 hours, and to be sure that his 
rumination was perfect before his last meal, so as to avoid tympani- 
tis, which even then may take place, although these precautions 
have been taken — especially when the firing is to last some time." 
These precautions are not necessary when the animal is operated 
upon standing ^ip. As p. general thing, all that is required is to 
place him in stocks or under the yoke ; he is seldom thrown down. 
The hair is cut short upon the region. It is better to use instru- 
ments of which the point or cutting part does not widen out too 
rapidly ; for, as the cautery goes deeper, it would generally leave 
large external wounds. 

For superficial lined or dotted firing, the rules followed with horses 
are applicable to cattle, increasing one-third the number of applica- 
tions of the instrument ; of course, taking note of the region where 



CAUTERIZATION FIRING. 



93 



the operation is performed. The signs of the three degrees of cau- 
terization remain the same. One must bear in mind, however, that 
' ' seldom are the eschars thrown off by suppuration ; when they drop, 
cicatrization is already complete underneath, and the hair growing. " 
(Lafosse. ) Since animals may do some mischief with their tongues, 
some precaution should be taken to prevent this. 

Deep and needle firing also give excellent results in the case of 
cattle. 

Faulon prefers the simple top-shaped cautery to that of Bourguet, 
though this or the Zoocautery work well. With one stroke, the 
needle, heated to a clear red, is pushed to a depth of 2 centimeters 
and a half, and may be inserted eight or ten times in each perfora- 
tion, when the firing is done for tendinous or bony lesions. One 
stroke is sufificient for synovial. 

After the firing, Faulon recommends the application of the oint- 
ment of iodide of lead with free iodine, made of: 

Iodide of Lead lo gram mes 

Iodine 2 do 

Lard 30 do 

In synovial dilatations, tendinous or articular swellings, especially 
if the firing has been light, he paints the region with one of the 
following : 

Laurel Oil 30 grammes 

Croton Oil o gram 05 

Or 

Oil of Turpentine )_, 

Laurel Oil ) *^ 

During the first days, the patients are kept in the barn, on clean 
bedding ; the crusts and scabs fall off from the loth to the 15th day ; 
the eschar after 20 or 25 days. 

Cauterization is little used in the treatment of small domestic 
animals. Firing, however, might be efficacious for bony and artic- 
ular lesions and paralysis met with in dogs ; but often its action is- 
imperfect against chronic articular diseases, especially the dry 
femoro-tibio-patellar arthritis so common among those animals. 

Superficial firing has given, according to some authors, recovery 
from lamenesses due to exostosis. Superficial points or lines are 
applied with light instruments. Four to six applications are suffi- 
cient. We use for our patients the penetrating needle of the Zoo- 
cautery, and for bones, tendons, or synovial membranes we make 
but one stroke. We place a wadded dressing over the part with a 
protective bandage. The muzzle has often to be put on. 



SECOND PART 



SECOND PART. 

DISEASES COMMON TO ALL TISSUES. 



CHAPTER I. 

INFLAMMATIONS— GANGRENE— FOREIGN BODIES 

I. 
INFLAMMATION. 

Whatever conception one may have of inflammation, — so varied may 
be its forms and causes, — it has never ceased to be a process that is met 
with in many of the very frequent diseases ; and as it is yet " the 
principal phenomenon of pathology," as in the past, it is proper to con- 
sider the general precepts for successfully overcoming it. 

The removal of the cause or the attenuation of its effects is the first 
thing to be considered in all cases of phlegmasia. If the inflammation 
is due to a foreign body implanted in the tissues, it should be extracted 
as soon as possible ; if mechanical irritations keep it up — the collar in 
the case of a dog, the harness in the case of draught animals, the shoe 
in some lesions of the foot — they must be removed ; and again, if, as 
observed in some skin diseases (eczema), or those of other tissues 
(rheumatism), the inflammation is due to a dyscrasical or infectious 
cause, an internal treatment must be instituted. 

Another precaution, which should be taken in all cases of inflammation 
in the beginning, is to insure the immobilization of the diseased part, 
and to keep it in a state of rest as complete as possible. 

Aseptic traumatk inflammations may be seen with various degrees of 
intensity, but they are seldom violent, and they naturally have a ten- 
dency towards resolution. Even the most severe do not resist for any 
length of time a well directed treatment. In their first stage, they are 
ordinarily treated with cold applications, with which one tries to control 
them, to moderate the congestive tendency, and to prevent the intersti- 
tial hemorrhages. Cold (water, ice, snow) produces a constriction of 
the tissues, a contraction of the blood vessels, and diminishes the hyper- 
a^mia of the inflamed parts ; under its influence, the heat, swelling and 
redness diminish. But its application must be long or continuous : if 
it is often interrupted, a reaction will follow the ease temporarily pro- 

97 



98 VETERINARY SURGICAL THERAPEUTICS. 

duced, and the benefit of the treatment will be lost. It is especially 
true in a limited phlegmasia that refrigerants are useful. Where cold 
water is applied in afifusions or fomentations often repeated, or by long 
immersions or continued irrigation, its action is almost always benefi- 
cial, and in many cases will be sufficient for simple phlegmasia. Cool- 
ing mixtures, much used in days past, are now abandoned, as is also 
refrigeration obtained with atomized liquids (ether). 

The experiments of Bayer have proved that irrigation and col'd bath;^. 
are superior to all other modes. The mud of clay, with addition ot 
common salt and vinegar, is irritating to the skin ; it may produce 
cracked sores, especially on the side of the fiexion of joints. 

Against some inflammations, astringent solutions are still much used 
(alum, metallic sulphate, salts of lead, and a mixture of alum and lead). 

Cold and astringents are not advised for any external inflammatory 
affection in any stage. Not only are they useless in infectious phleg- 
masia, but they may be injurious when there exist in the affected region 
extensive disorders, when numerous vascular currents are obliterated, 
and when tissues, bruised and ischaemated, seem threatened with 
gangrene. 

To assist the return of the circulation and stimulate the nutrition of 
these tissues, other means are necessary, among which damp heat 
comes in the first rank. Warm water (40-50 deg. C ) renders greatest 
service in the treatment of external phlegmasia, especially when 
situated in the inferior regions of the extremities. Warm affusions, 
damp compresses, especially balneation, have a most favorable action 
in the generality of cases where phlegmasia is recent, particularly when 
the tension of the tissues is severe and the pain acute : the inflammatory 
phenomena become circumscribed and diminish, the swelling and the 
pain subside. When these are excessive, it is advantageous to bring 
into action, upon the inflamed tissues, narcotic or analgesical sub- 
stances. The ointments of the old pharmacopia should be ignored ta 
give preference to the preparations with base of vaseline : vaseline, 100- 
grammes ; cocaine, 2 grammes ; or, vaseline, 100 grammes ; boric acid, 
to; antipyrine, 10; iodoform, 2. (Reclus.) 

Subcutaneous or submucous tissues, when inflamed, become phleg- 
monous, even when the surrounding tegument shows no apparent 
interruption of the continuity. Warm water is again very advantage- 
ous to conjure this complication.' It softens fatty matter dried on the 
surface of the skin, loosens it, and produces a sligh*- antiseptic effect. 
Irritants — revulsive or vesicatory agents — are at times used when one 
wishes to accelerate a process or to substitute an artificial for a morbid 
phlegmasia. It is thus that the reactionary inflammation is excited in 
*' stickfasts," " scabs" of the skin, by the applications on their borders- 
of a vesicating preparation ; it is also in this way that beneficial inter- 



INFLAMMATION. 99 

ference is obtained against some eczeniatous dermatitis by sliglit 
cauterization of the diseased surfaces with solution of nitrate of silver or 
nitric acid. At times, when the tissues are much swollen, scarifications 
are useful ; blood and serosity escape from them, the tension of the 
inflamed parts is diminished, the pain reduced ; but the objection to 
them is that they expose the tissues to infection, if they are not made 
aseptically, and the region covered afterwards with an antiseptic dressing 
or damp compresses. Deep scarifications may bring on cartilaginous 
quittor in cases of acute inflammation of the skin of the coronet, or dis- 
ease of the withers or of the poll, if the phlegmasia exists in these 
re-gions ; in both cases the complication exists on account of an inocu- 
lation produced during or after the operation. 

Almost all acute surgical phlogoses are infectious, brought on by 
micro-organi'sms. Prophylaxy, for such as can be cured, is said in two 
words : asepsis for the wou-nds of operations and antisepsis for acci- 
dental wounds. As soon as a microbic phlegmasia exists, the agents 
which have given rise to it must be destroyed by an antiseptic treatment, 
or their pullulation must be arrested. One method consists in ap- 
plying to the inflamed parts frequent warm lotions of corrosive subli- 
mate, carbolic acid, or creolin solution : they are especially useful in 
inflammatory diseases of the skin and of mucous membranes, as there 
is danger of the extension of the process to the subcutaneous connective 
layer. This treatment cleans off the surfaces, renders them aseptic and 
protects them against complications. 

When the region permits it, the application of compresses, dipped in 
the same solutions and often changed, is to be resorted to. If poultices 
are to be used, they must be prepared with phenic or creolin>ed water. 
Continued immersions or baths in a warm antiseptic solution are most 
useful, and in the case of small animals nothing is easier. They can be 
used for large animals when the inflammation is located in the foot or 
in the lower part of a leg : a large basin, tub or pail, resting on a bed 
of straw, and containing a weak solution of creolin (2 p. 100), carbolic 
acid (2 p. 100), or of corrosive sublimate (i per 1000), answers the 
purpose, the diseased part being soaked in it for 20 or 30 minutes. 
Warm antiseptic compresses and irrigations or baths give the best results 
in the treatment of phlegmasia; of the skin and of the mucous membranes 
(vulva, vagina and rectum), in periarticular inflammations, ulcerated 
lesions, diphtheritic lesions, and, in general, in all microbic affections. 
The liquid, absorbed by the cutaneous pores, penetrates into the tissues 
and into the lymphatics, and produces a most remarkable effect : the 
swelling diminishes, the pains subside, the tension becomes less, the 
phlegmasia is arrested and soon goes away. In numerous cases which 
look threatening, where suppuration seems likely to be abundant, recov- 



100 VETERINARY SURGICAL THERAPEUTICS. 

ery takes place in a few days, and if an abscess is formed, it always has 
small dimensions. In cases of lymphangitis of the extremities, so com- 
mon among horses where there are wounds of the digital region, this 
treatment renders the greatest service. During the intervals between 
the baths, the diseased part must be covered with antiseptic compresses. 

There are specific inflammations which require a very rapid interfer- 
ence and more energetic means, such as the carbuncular and septicaemia 
phlegmasia, when they are situated superficially and detected early. 
With them, one must resort to the destruction of the inflamed parts, or 
make in them deep scarifications or punctures with the hot cautery, and 
introduce deeply into the tissues bactericide solutions. (See Anthrax 
and SepticcEmia.) 

In inflammation of the subcutaneous tissues — connective layers, mus- 
cles, tendons, articulations and periarticular structures — when the pain 
is very slight or has been subdued, compression and massage constitute 
an excellent treatment, of which we shall speak later. According to 
the place of the diseased region and the degree of intensity of the in- 
flammatory phenomena, compression should be made with a wadded 
dressing or by the application of bands of flannel or linen, or of the 
elastic bandage. When it is likely to be a little severe, as the case may 
be with the elastic band, it must be used only at intervals, now and then, 
as otherwise cutaneous necrosis by ischsemia might take place. Before 
applying a compressive bandage, it is advantageous to submit the en- 
gorged part to methodical massage. The technique of massage is simple : 
The region is covered with vaseline, and rubbing or pressing is made 
upon it with the full hand, or the palmar surface of the thumbs, 'J7iese 
pressures, or '■^passes" must always be '■'■ ce7itripetal^^ made in the direc- 
tion of the venous and lymphatic canals. In some regions, the extremi- 
ties especially, it is necessary, in order not to be hindered by the hair, 
to cover the skin with a smooth tissue or a band of parchment. Mas- 
sage for five or ten minutes is sufficient. Light pressures are made 
first to numb the swollen part, and are gradually increased in force. 
These manipulations help the resolution by a mechanism easily under- 
stood : the clots of blood of the connective lamella are crushed, the 
exudations spread and are distributed into a wider cellular territory ; 
the resorption of the sero-sanguineous infiltrations is made active, since 
it takes place through more numerous channels. 

Chronic inflammations are also treated by compression, massage and 
alterative applications, exutories or cauterization. The last is the best 
means for obtaining the destruction of indurations following old phleg- 
masia. 

Some chronic inflammations are brought on and kept up by special 
parasites. To this group belong actinomycosis and botryomycosis. Up 
to late years extirpation was the only treatment of the new formation 



ABCESS. lOI 

due to these mycosic processes. To-day we have recourse to a specific 
medication : the administration of iodide of potassium internally, by 
the use of tincture of iodine, applied externally by painting or by injec^ 
tions. (See Actynomycosis and Botryoinycosis.) 

For the horse, iodine administered internally and injections of tinc- 
ture of iodine, pure or diluted (tincture, 4 ; iodide of potassium, 5 ; 
water, 20), have seemed to us to be a good treatment for some purulent 
old phlegmasite which do not belong to botryomycosis. 



II. 
ABSCESS. 

The great diversity of the clinical and anatomical characters presented 
by purulent collections admits of the following classification : war7n or 
acute and cold or chronic abscesses ; superficial and deep abscesses ; abscesses 
by congestion, forming in dependent regions ; general abscesses, develop- 
ing in the course of specific diseases (distemper, glanders) ; metastatic 
abscesses, appearing secondary to a suppurating lesion, as the result of a 
" metastasis " of the pus, and well characterizing pyohaemia ; critical 
abscesses, occurring in the course of some internal diseases and coincid- 
ing with an improvement in the general condition ; sudden abscesses^ 
which, in some animals exhausted by age, work, or previous diseases, 
appear suddenly, without noticeable local reaction ; uri?iary or stcrcorous 
abscesses, which follow the infiltration of urine or of foecal matter in the 
substance of the tissues. 

With the exception of some organs of obscure vitality (epidermis, hoof, 
teeth and cartilages), all tissues may become the seat of abscesses. 
These may therefore be seen almost in every part of the organism. 
They are frequent in some regions (maxillary space, poll, neck,-withers, 
point of the shoulder and inferior part«of the legs), and again rare in 
others (abdominal walls, croup, gluteal region and thigh). Venous and 
lymphatic abscesses are a great deal more common than arterial. 
Muscles and bones are less affected with suppuration than the skin and 
connective tissue. Generally, it is in this last that absesses develop : it 
is this which offers the greatest facility for pyogenesis. 

Suppurative inflammation maybe the result of the effect of numerous 
causes, but it is generally due to traumatic action. Some aljscsses, 
consequent upon the extension of the inflammation, occur in the 
neighborhood of the primitive lesion, or at some distance from it, in the 
lymphatic vessels or their collecting glands. Our publications contain 
a large number of curious observations about superficial abscesses, due 
to foreign bodies which have travelled a distance more or less great, 

■4 



102 VETERINARY SURGICAL THERAPEUTICS. 

through tissues (projectiles, needles, nails and other sharp metallic 
bodies swallowed by cattle, etc). The pathogeny of some varieties ot 
abscesses (critical or sudden) is yet imperfectly known. 

Suppuration does not establish itself Avith the same facility in the 
various domestic species ; under the head of "pyogenic aptitude," or 
the frequency of abscesses, these species are arranged in the following 
order : horses, sheep, swine, dogs, cats and cattle. 

Among horses, warm and cold abscesses of every size are very com- 
mon. Among cattle, they are undoubtedly less frequent, less rapid in 
their development, and ordinarily are surrounded by a thick, hardened 
layer ; although among young animals principally acute diffuse abscesses 
are also observed. Among dogs, diffused abscesses, " in sheets " (cv^ 
7iappe), with bloody pus and with copious oedema, are frequent. 

The bacteriological researches of the last twenty years, especially those 
of Rosenbach, Ogston, Strauss, Roser, Socin and Garre, have shown be- 
yond a doubt the microbic origin of surgical suppurations. All phleg- 
masias which bring on suppuration are the work of pyogenic microbes. 
The staphylococcus albus and aurens, the streptococcus pyogenis, and 
that of Schutz (microbe of distemper), are the most frequent. The 
yellow staphylococcus of Babes, the citrinus, the foetid hacilhis pyogoiis 
of Passet, the pyogenic microbe of Pasteur, bacillus coli, and several 
others, whose presence has been detected in the pus of some abscesses, 
have a less important part to play. According to Lucet, among cattle, 
ordinary abscesses are due to special micro-organisms. 

The pyogenic agents penetrate the tissues through the presence of a 
wound or the interruption of the continuity of the epithelium or 
epidermis ; often, also, they are carried into them by sharp substances. 
Suppuration does not unavoidably follow in all cases where the animal 
tissues are thus invaded by these microbes. Unless there is additional 
help (local ansemia and alterations of anatomical elements), " positive 
inoculations " ordinarily require a large number of microbes. Fehleisen 
tells us that sometimes one cubic centimeter of a culture of staphy- 
lococci or of streptococci is necessary to bring on suppuration. Wat- 
son Cheyne estimates that for an abscess in the rabbit — an animal 
whose "pyogenic aptitude" is well marked — 250 millions of cocci are 
required to make the tissues react, and Bujwid, in order to reach the 
same results, had to inject several millions of staphylococci. 

Several authors (Ponfick, Gravitz, de Bary, de Christmas) have sue-- 
ceeded in bringing on suppuration in subjects from among certain 
species of animals by injecting aseptically, under the skin or in the eye, 
amicrobic irritating substances (nitrate of silver, mercury, or oil of 
turpentine), or sterilized cultures of pyogenic microbes. It has beeru 



ABSCESS. 103' 

Tecognized that the products of the secretions of the germs of pus are 
themselves phlogogenic and pyogenic. Arloing has observed that the 
toxines, elaborated by the staphylococcus aureus, produce an active 
cellular hyperplasia, the rapid death of the newly formed cells, a disso- 
lution of the intercellular substance, and, by reflex action, a vaso-dila- 
tation which accelerates the diapedesis. Then, in last consideration the 
microbes of suppuration would stimulate it by the pyogenic substances 
that they produce, and suppuration would be but the effect of a re- 
action of the tissues against some irritating substance, whether produced 
by living beings or others of a purely chemical nature. 

But, interesting as those data of experimentation are, they are not to 
be taken into consideration from a practical point of view. All sup- 
purative inflammation that we meet with among our patients, is to be re- 
garded as microbic ; all is to be considered as the result of an infec- 
tious process. 

In general, phlegmons are isolated occurrences, with a more or less 
rapid development ; it is not, however, rare to observe several simul- 
taneously on the same subject, either in the same, or in different re- 
gions. We have seen on one leg of a horse or of a dog, numerous 
cutaneous and sub-cutaneous abscesses, brought on by the two staphy- 
lococci. Eberhart has described a kind of " phlegmonous diathesis," 
which, in one case of a horse, was manifested for seven months by 
abscesses on the four extremities. Hiibner treated a horse upon which, 
in the course of two months, 250 abcesses appeared ; some of these were 
the size of a child's head. 

Whether the development of the abscesses be quick or slow, whether 
the local phlegmasic phenomena be slightly marked or acute and gener- 
ally disturbing, the signs obtained by the explorating puncture of a 
tumour rarely leave room for a doubtful diagnosis. In doubtful cases, 
that of an abscess of the thoracic or of the abdominal walls, or of 
•deep abscesses of the neck and extremities, the nature of the diagnosis 
TTiust be at once established by a probing aseptically performed. 

An antiseptic treatment of any traumatism is the surest way to avoid 
■abscesses. During winter and rainy seasons, wounds of the lower 
parts of the extremities, soiled with mud, are often complicated by- 
gangrenous phlegmons. These can be prevented by disinfecting the 
"wounds and covering them afterward with a dressing, or with a coat of 
■oil of cade or of tar. (Moller.) 

Let us flrst consider the indications of the therapeutics of warm 

JiLBSCESSES. 

We have seen the means by which acute inflammation, threatening 



104 VETERINARY SURGICAL THERAPEUTICS. 

suppuration, can be overcome. By tepid antiseptic compresses, warm 
baths, emollient and analgesical preparations — if pain is great, scari- 
fications made with care — sometimes the metamorphosis of the phleg- 
mon into an abscess may be avoided ; but this is only in a limited num- 
ber of cases. When the phlegmasia is of an infectious nature, the 
abortive treatment almost always fails. When once the pyogenic 
microbes have collected in a mass in the inflamed tissues, suppuration 
is scarcely avoidable. In days past, the absorption of the pus of 
recent abscesses of small dimensions was often attempted, by making, 
upon the region where the purulent collections existed, repeated applica- 
tions of camphorated ointment. This treatment was sometimes success- 
ful in the case of man (Velpeau says he used it with advantage) ; but 
the cases where it proved successful were exceptional. This method is 
now abandoned. 

In order to make the pyogeny active to reduce to a minimum the 
duration of purulent infiltration, and to precipitate the formation of the 
abscess, sometimes emollients, sometimes vesicating agents, are used. 
In general, as soon as the inflamed tissue suppurates, the pain resulting 
from the inflammation diminishes ; if it continues sharp, one may, ii-i 
the case of irritable subjects, continue the measures prescribed for acute 
inflammation. For a long time, the ointments of poplar, belladona, 
camphor, and the camphorated and opiated oils were the most generally 
used agents ; many veterinarians employ them still. Emollient and 
analgesical preparations made with vaseline begin to be preferred now. 
"When the region permits it, warm baths give the best results, especially 
in the treatment of phlegmons of the extremities. 

The systematic use of vesicating agents to accelerate tlie formation 
of a pyogenic group is an essentially veterinary measure. These agents 
excite the inflammation, accelerate the purulent degeneration of the 
tissue ; and the time when the abscess is ready to be opened, as well 
as that when the animal can be returned to work, is shortened. 

The abcess is formed ; evident fluctuation proves it. Must it be 
opened immediately in all cases, or must one wait for its spontaneous 
opening ? Superficial abscesses, it has been advised, should be left to 
themselves, and in general, those whose pus may easily progress 
towards the skin. But this waiting has its inconveniences ; it delays 
recovery, carries with it a cutaneous necrosis more or less extensive, and 
is not free from serious dangers. Abscesses formed in the neighborhood 
of articulations or of tendinous sheaths may open in those cavities ; those 
of prepectoral glands and of the thoracic walls, in the pleura ; those 
of the abdominal walls, in the peritoneum. Our publications contain 
numerous examples of fatal accidents thus produced. Therefore, at 
present, the puncture of an abscess is the absolute rule. 



ABSCESS. 105 

But at what time must it be made ? Generally, one should wait until 
the abscess is ripe. If the puncture is made when the pus is not vet 
entirely gathered, secondary centers may form in the inflamed zone and 
impose other interferences. 

Numerous cases are observed, however, where the veterinarian is 
obliged to make the premature opening of purulent collections. When 
these are deeply situated, under aponeurotic fasciae or in the neighbor- 
hood of a splanchnic cavity, of a synovial or tendinous sheath, or close 
to a large blood vessel, a bone, a tendon, a ligamentous cord or the 
fibro-cartilages of the foot, then they must be opened at once, if serious 
complications are to be avoided. The attractive theory of the constant 
tendency of pus to progress towards the tegumentary surfaces has seen 
its days. Examples are not rare of inflammations of the great serous 
membranes, of articulations, or of necrosis of organs with dull nutrition, 
induced by abscesses, the lancing of which had been too long delaved 
Thus, s-alivary, stercoral and urinary abscesses, where numerous bac- 
teriae will unite to bring on gangrenous or septic accidents, should be 
lanced at once. Also, purulent collections, in regions where they may 
interfere with the execution of important functions, must be opened as 
soon as they are recognized by sure signs. In this place, we may 
mention especially the sub-parotid abscesses which interfere with 
deglutition or respiration -, those developed in the pelvis, which com- 
press the rectum ; those of the scrotal region, which may close up the 
sheath, prevent erection and interfere with micturation. In case of 
the horse, the same rule is to be observed for abcesses of the digital 
region, and for purulent gatherings under the hoof : the former have at 
times a rapid development ; under the cutaneous chorion, which is very 
resisting, the pus spreads, gives rise to excessive pains, macerates the 
tendons, fibro-cartilages, and the bones, and sometimes reaches one 
of -the phalangeal joints ; the latter, unable to make their way through 
the horny covering, rapidly separate it from its tegumentar)- membrane 
underneath, and, before escaping at the coronet, produce in the tissues 
of the foot most serious disorders. At this point, we may understand 
that phlegmons vary as to gravity, and spread more or less rapidly, 
according to the microbic species which has caused them. Ordinarily, 
those originating from streptococci are more diffused and affect more 
the lymphatics than those due to staphylococci. 

Abscesses may be opened with the bistoury, froMr, or with the cautery. 

The straight bistoury is most commonly used to lance abscesses. 
The sharp edge of the instrument should be turned upwards or down- 
wards, as the case may be ; the thumb and index, resting on the sides 
of the blade, more or less close to the point, according to the depth of 
the cavity to be opened, should limit the introduction of the blade. A 
narrow incision is sufficient for superficial abscesses ; if they are large, 



I06 VETERINARY SURGICAL THERAPEUTICS. 

a free cut is required. For some deep abscesses, especially in the 
regions where organs exist which must be respected, the tissues should 
be divided layer by layer ; in some cases, it is wise, where once the skin 
is cut, to lay the bistoury aside and divide the tissues underneath with, 
he grooved director, the incision being afterwards enlarged with the 
scissors or a blunt blade. In general, the incision is made parallel to 
the muscles and to the vasculo nervous trunks of the region. 

When one opens an abscess of the canon, fetlock or digital region 
the sharp edge of the bistoury must always be directed towards the 
shoulder. If it is directed towards the foot, and the animal, not suffi- 
ciently under control, or irritated by the pain, should move his leg 
suddenly, the tissues might be divided deeply and extensively ; and if 
the abscess is on the sides of the fetlock, the digital blood vessels might 
be opened, the ligaments or tendons cut, and the articulation opened. 
We have seen in this way the division of the digital artery. 

There are regions where a puncture, as simple as it may appear, 
gives rise to serious results when it is not methodically performed. 
Before plunging the instrument into the abscess, one must take 
into consideration the exact situation of the blood vessels, and bear i»n 
mind that those may be displaced by the purulent collection. In push- 
ing the bistoury deeply into such regions, an artery, a vein or a nerve 
may be wounded, and as the result, a hemorrhage difificult to control, or 
paralytic accidents may follow. Suppurative phlebitis has been more 
than once the consequence of punctures made without sufficient care. 

The opening of the abscess must be made in the most dependent 
point, so as to allow the free exit of the pus. It is not necessary that 
it should be large ; the discharge keeps it open until cicatrization is 
complete. The custom of introducing the linger into the cavity to 
break the band that may be found in it is not necessary, since i-n this 
way tissues which may serve for cicatrizaiion are destroyed, or vascular 
or nervous branches torn. An examination of the cavity ought not to 
be made except for the sake of finding out the arrangement of its parts, 
or of seeing whether it contains foreign bodies, has cul-de-sacs, or con- 
tains pockets where the pus, collecting, may give rise to purulent infil- 
trations. When the puncture is made at the lower point, and the pus 
escapes as it is formed, recovery follows quickly. But if the purulent 
cavity is large, it is advantageous, after it has been washed with an 
antiseptic solution, to place in the opening a " rubber drain " with 
thick walls, and sufficiently large to allow the running through it of the 
albuminous masses, clots, or remains of necrosed tissues. 'J'his drain 
is fixed to the cutaneous borders of the wound by a suture of a stitch or 
two. 

In regions where there are pockets, more or less deep, in which the 
pus collects, and cannot be squeezed out except by pressure below the 



ABSCESS. 107 

incision, the inflammation continues and the granulating process is 
delaj'ed. There are two ways of overcoming this stagnation of the pus, 
namely, by a larger wound or a counter opening. If the pocket is small 
and below the puncture, division of the tissues is not dangerous and the 
wound may be enlarged without danger ; otherwise connkr openi-ngs 
should be made. They are necessary in deep abscesses of the throat, 
neck, poll, withers, abdominal walls, or extremities ; and if interference 
has not been made early, wide undermining soon takes place, the bottom 
of which is ordinarily far below the point of the original puncture. 
Counter openings can be made by introducing through the incision of 
the abscess a curved director, which, pushed towards the bottom of the 
pocket, raise the walls of the abscess, which are then divided from out- 
wards inwards. If the director is not used, the exact situation of the 
bottom of the pocket is made oat with the finger, and at a correspond- 
ing point the skin and subcutaneous tissues are punctured from out- 
wards inwards. A fenestrated drain is then put through this second 
opening and secured. Several counter openings may be required : they 
are made in a similar way. For drainage, tents^made of oakum, disin- 
fected horse-hair, or silk-worm gut are used, but the rubber tube is 
better ; the escape of the pus is easier. Injections into the purulent 
cavity, to wash it out, are also very advantageous. 

To open the abscesses of mucous cavities a long trocar or a straight 
"bistoury (protected by cotton or wadding wrapped round the blade within 
two or three centimeters of the point) are used. Some abscesses of the 
rectum can be opened with the index finger thrust suddenly through the 
rectal mucous membrane, which is thin at the zone of fluctuation. For 
others, are recommended a concealed bistoury, or one used for the punc- 
ture of the vagina in ovariotomy. 

Atone time the cautery was extensively used for opening abscesses. 
This has the advantage of giving rise only to slight hemorrhage, and 
does not have the danger of possible slippings of the instrument, and 
therefore the cutting of nerves or large blood vessels, if the animal sud- 
denly struggles. But it will escape the blood vessels or nervous bands 
of the inflamed centre no better than the bistoury, if it be introduced 
in their tracts. If the cautery be selected, one should take a long 
pointed one, heated to white heat, place it upon the centre of the growth, 
and by a double movement of pressure and semi-rotation push it in, 
until a sensation of resistance overcome is perceived, which indicates 
that the cavity is entered. The pus sometimes escapes immediately, 
but sometimes not until the instrument is withdrawn. 

The trocar has been recommended for opening deeply situated 
abscesses or those of regions containing large vascular branches which 
might be divided by the bistoury ; but, like the cautery, it does not 
always escape those organs, and in the zones which are called " dan- 



I08 VETERINARY SURGICAL THERAPEUTICS. 

gcrous,'^ especially the parotid region, one should rather prefer to the 
cautery or the trocar the following modus ofera/idi: with the point of a 
straight bistoury, a simple cutaneous puncture is made in the centre of 
the phlegmonous tumor, a grooved director is then thrust, by its dull 
extremity, into the tissues until it has reached the centre of the cavity ; 
by moving the director up and down, the tract it has made is enlarged. 
Then draw it out and replace it with scissors having dull points. Then 
when the director is removed, with their blades open and separated, 
lacerate the tissues without danger of injuring important organs, and, 
at the same time, leave a wide opening for the escape of the pus. A 
counter-opening is made in the same manner. This technique is superior 
to all others. 

After the abscess is opened, and before the drain is placed, the parts 
should be washed with an antiseptic solution — preferabl}' carbolic acid 
(3-5 ^), corrosive sublimate (i in 1000), cresyl (3-5 fc), or tincture of 
iodine. During the days following, until the cavity has all granulated, 
two or three similar injections should be made through the drain tube. 
Of course those should be made in various quantities, according to the 
fetid odor of the pus and the seat of the abscess, which might suggest 
the possibility of infectious complications. When the discharge has 
a tendency to dry, the drainage tube should be taken off. Atomizations 
of iodoform ether, used by some practitioners, are not any more ad- 
vantageous than simple antiseptic injections. 

When the suppuration lasts a longer time than abscesses ordinarily 
require to be filled, the wound becomes fistulous, and various secondary 
lesions may exist. Sometimes it is because of a foreign body that 
must be extracted, or of an undermining where the walls have to be 
modified, or it is on account of a necrotic lesion which, if it will not 
yield to strong antiseptic solutions, must require another operation. 

Septic or gangrenous phlegmons should be opened at once and treated 
with strong disinfecting solutions. If there are portions of necrosed 
tissues, they should be cut away. Continuous irrigation may also be 
used with advantage. 

After the pyogenic membrane has been cleaned, a slight pressure to 
bring the walls of the sac more or less closely together, will accelerate 
the cicatrization. Some authors, considering the lining membrane of a 
warm abscess like the surfaces of a fresh wound, suggested bringing the 
walls close together, after the careful and complete washing of the 
cavity, in order to try to obtain union by first intention. This practice 
generally failed, although it was of advantage in reducing the dimen- 
sions of the cavity and in shortening the duration of the cicatrizations. 
With antisepsis, the adhesive reunion of the walls of the abscess has 
been attempted, after the walls have been cleaned with the curette and 
disinfected with a strong carbolic solution. The results obtained, how- 



ABSCESS. 109 

ever, have not been encouraging. In the generality of cases, the sur- 
faces, thus prepared and opposed to each other, continue to suppurate. 
Sometimes the tissues, where the abscess has developed, remain tume- 
fied for a long time and become indurated. The best treatment for 
such consecutive indurations, is cauterization with penetrating points. 

The " hemorrhagic phlegmon " of oxen is generally produced by pricks 
of the goad with which they are driven ; sometimes it has been observed 
after a violent blow, and also without any well known cause (Guittard)- 
In some cases it is on the outside, in others it is deeply situated in mus- 
cular interstices. 

It is characterized at first by a large, diffused, renitent swelling, more 
or less painful, which later becomes fluctuating. It is easily distin- 
guished from serous collections and from the crepitating tumors of 
symptomatic anthrax. 

Cold abscesses differentiate from the preceding by a weak degree 
of inflammatory reaction, or its absence altogether. The nature and 
etiology of these are no less complex than of those of an acute charac- 
ter. Tuberculous abscesses, so common in the human species, are excep- 
tional in our domestic animals. 

When multiple tumors develop rapidly and simultaneously in various 
regions of the body, they are not always, as often supposed, cold puru- 
lent collections. Sometimes they are true neoplasms ; sub-cutaneous 
sarcomas may develop somewhat rapidly, and resemble cold abscesses. 
We have observed a remarkable case of this kind among horses. 

Hard cold abscesse^s, freq-uent among horses, in regions which support 
the various parts of the harness (point and anterior border of the 
shoulder, poll, superior part of the neck, withers, girth) do not get well 
except by puncture. The central purulent collection in them is often of 
small size ; and several probings maybe necessary to open it. These 
probings are made with the straight, narrow-bladed bistoury, which is 
thrust deep into the tumor. As soon as the centre of the abscess is 
reached, if the pus exists in any quantity it escapes this way to the 
surface. But the white {blanche) puncture, which fails to bring out pus, 
does not necessarily mean that the abscess has no pus ; often the 
bistoury does not reach the spot where it is, or passes alongside of it, 
or the pus is so thick and caseous that it has no tendency to escape 
through the way thus made. One need not hesitate to make new punc- 
tures, and several tracts towards tlie centre of the indurated mass ; in 
most cases the purulent cavity will be reached finally. But if the prob- 
ing still remains fruitless, the inflammation which it causes is not with- 
out a useful effect ; the pyogenic process is quickened, and the pus, 
increasing in quantity, finally appears through one or another of the 



I lO VETERINARY SURGICAL THERAPEUTICS. 

openings made by the bistoury. The condition for the continuance 
of the inflammatory tumor is removed, and the tumor then gradually 
diminishes and soon disappears. 

In numerous cases, it is necessary to enlarge the tract, from which the 
pus flows. This is done with a bistoury, guided by a director, to make 
a larger incision ; or by using a cautery heated to white heat, which is 
thrust into the tract. A tent or a rubber drain is introduced and secured 
in the wound when the enlargement of the incision has been made with 
the bistoury. The drain, which insures the flow of the pus and allows 
antiseptic or irritating injections, as the case may demand, into the 
wound, is always preferable to a tent introduced into the tract of the 
abscess. 

Many practitioners use the cautery. It is not only dipped into the 
indurated mass or introduced into the wound made by the puncture to 
enlarge it, but it is also used to make a certain number of deep points, 
to stimulate the resorption of the newly formed tissue. Often a vesicat- 
ing preparation (blister, mercury ointment, or biodide of mercury oint- 
ment) is applied all over the surface of the tumor to complete the oper- 
ation and the action of the cauterization. The same means may be 
used when the exploring punctures have failed to reach the abscesses. 

When the cold abscess is in a region full of important organs (blood 
vessels, nerves, and synovial membranes), the bistoury and the cautery 
are not to be introduced deeply. The directions given in the chapter 
on warm abscesses must be followed for these. Puncture with the 
grooved director, after incision of the skin, is the best mode. 

Soft cold abscesses should be opened in their most dependent part, 
drained and irrigated afterwards with strong antiseptic solutions. 

During distemper, voluminous cold abscesses may be seen appearing 
in various regions ; they rapidly become fluctuating and ordinarily con- 
tain a large quantity of pus. Their treatment does not differ from that 
of ordinary abscesses : puncture, enlargement of the wound or counter 
opening, drainage and frequent antiseptic injections. 

Local secondary purulent collections, including congestive abscesses, re- 
quire the same care, besides attending to the treatment suggested by their 
various causes (necrosis, caries, phlebitis, inflammation of synovial 
membranes, wounds of the oesophagus, of the rumen or of the urethra). 
Multiple abscesses of the inferior regions of the extremities are some- 
times accompanied by swelling of the leg, which may end in elephantiac 
fibroma, when the rapid resolution of the phlegmasia is not obtained 
by antiseptic balneation. 

In cases of cold abscesses due to a diathesic condition (lymphatism, 
rheumatism or anaemia) a general medication should be resorted to 
(good hygiene, strengthening food, arsenical and iodous preparations). 

The treatment of some dyscrasic abscesses (glanders) calls for no 
attention. Animals which suffer from these should be killed. 



GANGRENE. I I I 

III. 
GANGRENE. 

Bacteriological discoveries have caused gangrene to be divided into 
the aseptic on tlie one hand and the septic or infectious on the other. 
We shall study the latter with the complications of the various trauma- 
tisms. For the present we shall only consider microbian mortifications 
and f/Vvv/wjT/'v'/v^/ sphacelus, in the genesis of which bacteria have played 
a more or less active part. 

On account of the multiplicity of the causes and of the complex 
pathogeny of those gangrenes it can easily be understood that preventive 
measures vary greatly according to circumstances. Let us observe, 
however, that the git /ig/e/ies of ncn'ous origin (brought on by neuritis or 
by lesions of the centres), those of a theromatous ?ind diabetic, as well as 
those following thrombosis and embolism, are very rare in animals. 

We shall first set forth the treatment of gangrenes, considered from 
a general point of view ; afterwards we shall examine the therapeutics of 
the two principal forms of sphacel of the soft tissues. 

The prophylaxis of gangrene includes means deducted from the 
numerous etiological conditions likely to produce it. When once the 
influence of these conditions is attenuated or annihilated, one must, by 
appropriate treatment, stop the processes which may bring on mortifica- 
tion of the tissues. Among working animals, cutaneous gangrene of 
the regions injured by the harness can be prevented, by seeing that 
they are in good condition, and are supple and exactly adapted to the parts 
with which they are to come in contact. In the case of disabled animals, 
which, on account of pain, are obliged to keep a reclining position for a 
number of days, the same object will be reached by providing them with 
a thick bed, free from injurious foreign substances, or by obliging them 
to rest first upon one side of the body, then on the other (by turning 
them over). One should bear in mind that blisters and caustics, applied 
in excess, have at times a violent action, which, extending beyond the 
desired effect, bring on the mortification of the tegument and of the 
first sub-cutaneous layers ; and also that the cautery, which we use so 
frequently, easily produces similar results, if it is applied in violation 
of the established rules, is put on too hot, or left too long in contact 
with the skin. In cases where the extremities have been injured, where 
the permanent application of a bandage or of a more or less compres- 
sive apparatus is required, sphacel by arrest of the circulation may 
be avoided either by using only methodical and moderate pressure 
upon the iniured region, or by spreading the apparatus over the entire 
extremity below the seat of the wound, beginning the application of the 



112 VETERINARY SURGICAL THERAPEUTICS. 

bandage at the digital region. In cases of very severe inflammation of 
the skin and sub-cutaneous tissues, one should endeavor to keep up a 
sufficient circulation, and the changes necessary for the physiological 
functions of the cellular elements; and should also provide against deep 
disorders and alterations incompatible with the presence of life, by 
actively overcoming the phlegmasic phenomena, and above all by using 
the means which antisepsis gives us. Deep scarifications, division of 
the aponeuroses pressing upon the tumefied structures, often produce 
remarkable results. In cases of violent contusions or of wounds from 
extensive bruising, having a wide ischemic zone, damp compresses or 
warm antiseptic baths are to be recommended : the innervation will 
then return, the collateral circulation will become more active, the 
anatomical elements, for a moment in danger, will by degrees recover 
their original activity ; for the wounds of contusion, the extensive morti- 
fication threatened will be reduced to its minimum, carrying only a few 
mortified shreds from the edges of the traumatism. How to prevent 
several gangrenes of toxic origin, especially that due to ergotism, has 
been known since the day when facts established the intimate connec- 
tion existing between the ingestion of food altered by toxic products and 
the appearance of gangrenous disorders in animals which ate this food. 
The only way is to stop its use immediately, change for some other food, 
or make the stock pasture somewhere else. But economical reasons, 
which dominate all questions relating to the keeping and preservation of 
stock, would often have rendered the execution of these prophylactic 
measures very difficult if gangrene by ergot had not become so rare in 
most of the countries of Europe. As far as necrotic accidents are 
concerned which may result from central or peripheral nervous centres, 
— diabetes, thrombosis and embolism, — there is no efficacious prophy- 
laxy against these. 

Properly speaking, there is no curative treatment of gangrene. One 
cannot, indeed, expect to return life to necrosed tissues. Several rules 
ought to be observed, however, to hasten the slough of the dead parts 
and assist the work of repair. 

To limit the extension of the gangrene, assist the elimination of the 
eschars, and hasten the picatrization of the wounds remaining ; such 
are the principal rules of interference. 

When death has taken place more or less extensively in the tissues, 
the most important thing, if one wishes to confine the destruction, is to 
arrest at once the action of the causes which have produced it. Gan- 
grene of a cutaneous spot, brought on by compression, is prevented 
from spreading, both in width and in depth, by putting a limit to the 
compression. By an energetic interference in the case of gangrene from 
severe phlegmasia one may avoid the formation of new sloughs within 



GANGRENE. II3 

the neighborhood of the centre of mortification. Though, let us re- 
mark, that if infectious gangrenes are ordinarily rapid in their progress, 
ordinary sphacels have but little tendency to radiate. The bistoury or 
the cautery are used only to permit the discharge of eschars infiltrated 
with liquids or the introduction of antiseptic preparations into the net- 
work of the tissues in order to prevent putrefaction. In the great ma- 
jority of cases, one uses either repeated carbolic or corrosive sublimate 
lotions upon the dead tissues and the surrounding parts, or continual 
bathing in those solutions. At this stage, the disorders produced by 
gangrene can be determined. There are cases where the sphacel has 
extended so much in width and in depth, and has made such ravages, 
that recovery of the patient cannot be expected. Gangrenes due to the 
obliteration of a vascular trunk demand the immediate killing of the 
animal. Those which involve only superficial layers — skin and tissues 
underneath — are sometimes serious in their consequences, when they 
are in the neighborhood of joints or tendons ; they often are complicated 
with synovitis, arthritis with or without necrotic accidents and after- 
ward cicatricial retractions. One must foresee these complications, 
avoid useless expense, and as quickly as possible come to a conclusion 
as to the future recovery of the patient. 

As soon as gangrene has ended its work the surrounding parts be- 
come inflamed, and by their reaction of the mortified territory is settled 
in its boundaries. This is a natural and constant phenomenon, which 
is accomplished more or less rapidly according to the extent of the 
slough and the vitality of the parts involved. If the separation is slow, 
it can be hastened by exciting reactionary phlegmasia with irritants 
(blisters, or any cantharidal preparations, etc.) ; if, on the contrary, the 
elimination of the gangrenous masses is accompanied by an intense 
inflammatory reaction, and the surrounding tissues are much swollen, 
then warm lotions, often repeated, of antiseptic solutions, pure or mixed 
with narcotic substances, according to the degree of the pain, should be 
employed. If the pain is excessive, preparations of cocaine are useful. 

As the boundary fissure increases, the pus increases ; if its escape 
is prevented, or if it accumulates in the dividing trench, frequent disin- 
fecting washes, or the use of absorbing or antiseptic powders is good, 
as well as the making of counter openings and the placing of drains. 
The eschars, macerated by the pus, infested with numerous micro- 
organisms, putrefy rapidly, and spread over the wound liquids with re- 
pulsive odor, favoring infections and poisons the organism. In such 
cases, continued irrigation is beneficial. To it as well as to the antisep- 
tics one must also have recourse when there are important organs deeper 
down which may yet be healthy. Often the greater part of the slough is 
•excised or removed by actual cauterization. This last mode is prefera- 
able to the use of potential caustics, which used to be placed on the 



114 VETERINARY SURGICAL THERAPEUTICS. 

eschar, and which, uniting with it, rendered it imputrescible. If caustics 
are deposited in small quantities over large and thick eschars, they are 
harmless, but their action may spread and corrode healthy structures. 
It has been wrongly said that they have an especial affinity for diseased 
tissues, and that, if they are used with care, their destroying action re- 
mains limited to gangrenous soft parts, as to suppurating or carious 
bony tissues. As Reclus remarks, the legend of the " intelligent caus- 
tics " is no longer current. When the sphacel is extensive, instead of 
destroying the whole of the eschar, one may make with the red iron 
scarifications close to one another, which having partly burnt, are after- 
wards filled with disinfecting powders or liquids. 

When the process of elimination is completed, the wound resulting 
from the slough of the mortified tissues is at times simple and covered 
with a layer of active, healthy granulations, and requires the same treat- 
ment as solutions of continuity with loss of substance ; at other times it 
is complicated with necrotic alterations (aj^oneurosis, tendon, liga- 
ment, bone), or with lesions, involving large blood vessels,' and with in- 
flammation of a synovial or of a splanchnic serous membrane. 

The general treatment is important only in gangrenes of a dyscratic or 
infectious origin. Narcotics should be used only in cases where the 
pain is great. Antiseptics are always useful when the sphacels are 
extensive and threaten infectious accidents. Local disinfection is 
always far more important than any of the various internal medications 
recommended. 

There are special rules for the treatment of gangrene according to 
the form it assumes. 

Dry gangrene, which we meet most frequently in animals, v^'hether due 
to the compressive action of the harness or to continued decubitus, are 
generally accompanied by sharp pains while the process of sloughing^ 
goes on. According to their seat, they are treated sometimes with 
emollient or narcotic preparations of vaseline, or most commonly with 
vesicating agents which are better to quicken the slough of the eschars. 
These, generally dried up and parchment like, putrefy only on their 
borders, where they are macerated in pus; they do not, as in moist 
gangrene, expose the pa^-ts to infectious accidents ; there is no objec- 
tion to leaving them entire and intact until they drop. Partial excision, 
however, is advisable for the extensive stickfasts of the withers and of 
the neck, which have such an offensive odor. If the suppuration is 
abundant, free disinfecting washings are to be insisted upon. In no 
case are the scabs to be torn away, no more than other eschars 
resulting from a dry mortification ; doing so might produce secondary 
necrotic lesions in the cervical or dorsal regions or in the lower part of 
the extremities ; and in the neighborhood of a joint, it might be followed 



ULCERS. 115 

by the opening of the synovial sac. In cases where the fissure of separa- 
tion is very deep, the pus abundant, and its escape difficult, several 
incisions may be made to relieve the difficulty. 

With moist gangrene, as with the preceding, the work of defining and 
eliminating the eschar must be trusted to nature. Interference here 
should also be limited ; assist the work of demarcation and prevent 
with disinfections the accidents likely to follow the putrefaction of dead 
tissues. The wound should be frequently washed w'ith antiseptic solu- 
tions (strong preparations of carbolic acid, creolin, chloride of zinc or 
of lime, or of permanganate of potassium) ; thus, the odor from the 
putrefying tissues will be much less marked. The powders of coal or 
of coal tar, thrown upon the mortified parts and into the fissure of the 
slough, will also diminish this odor very much and absorb the gas 
escaping from the decomposing tissues. As soon as the eschar is loose, 
its superficial layers can be cauterized, or excised with the bistoury or 
the scissors, being careful not to touch the sound structure. If pain is 
severe, the inflamed tissues should be covered with boricated or iodo- 
formed vaseline to which cocaine has been added. The antiseptic 
washes should be applied frequently until the wound is covered over its 
entire surface with granulations. Incisions along the edges and counter 
openings are more dangerous in this than in dry gangrene ; they would 
better not be made unless they are urgent, and then they must be- 
made with the actual cautery. 

Diabetic gangrene (dog) receives the same local treatment as the moist 
form. Besides this, an antidiabetic regimen should be instituted (meat, 
milk, exercise), with the internal administration of antipyrine, alcalines, 
and arsenic. 



IV. 
ULCERS. 

In a general way, all suppurating wounds, without tendency to cica- 
trization, deserve the name of ulcers. Glanders, tuberculosis, carcino- 
sis, and scurvy give rise to symptomatic ulcers, simple accidents of the 
infections to which they are related. 

The group of idiopathic ulcers has been considerably reduced by the 
progress of pathological anatomy. It only contains now ulcers from 
" unknown causes," and seems condemned to disappear soon from the 
nosological list. These ulcers are the consequence of arterial, venous 
or nervous lesions, which reduce locally the resistance of the tissues 
and seem to be under the influence of diathetic states, especially of 
arthritism. They are less frequent in animals than in men. 

From the surgical point of view, we will recognize : i. Inflamjnatory 



Tl6 VETERINARY SURGICAL THERAPEUTICS. 

ulcers, which are the seat of phlegmasic phenomena, more or less 
severe ; 2. Ftnigous ulcers, characterized by exuberant granulations ; 
3. Atomic nlce?'s, without vital reaction of the affected tissues ; 4. Callous 
ulcers, with indurated borders, cartilage-like, due to a chronic inflam- 
mation of long duration ; 5. Phagedenic ulcers, which spread rapidly 
by a quick and continued mortification of the borders. 

A great number of ulcers, especially those which result from a chronic 
simple phlegmasia or from repeated irritations, get well rapidly ; for 
these, all that is required is to place the diseased region under favor- 
able conditions, protect it from the influences which have given rise to 
it, and continue the same course. Others, notwithstanding the taking 
of energetic measures, require a long time to heal. According to the 
case, antiseptics, excitants, caustics, the bistoury or the red iron are to 
be used. 

Faiiiful, erethistic inflaimnatory ulcers must be treated with sprayings 
or warm antiseptic baths, and cocained or iodoformed vaseline appli- 
cations. Wadded dressings, covered with an elastic band to apply 
moderate pressure, are often beneficial. 

Against fungous ulcers, astringents may do good. But at times the 
granulations must be destroyed with caustics (nitrate of silver, sulphate 
of copper, chromic acid or permanganate of potassium), with the cautery, 
or be excised with scissors, the bistoury or the curette. Antisepsis and 
elastic compressions do the rest. 

Atomic ulcers are treated with light and repeated cauterization of 
nitrate of silver or the hot iron, then with antiseptic dressings. 

To bring a more active vascularity to callous tilcers, and keep in them 
the necessary hyperemia for granulating, one must use damp heat, alone 
or combined with elastic pressure. There are cases where recovery is 
obtained only by destruction of the edges of the wound, with the bis- 
toury, caustics or the actual cautery. 

Phagedenic ulcers require a quick interference. They are treated 
with the solutions of carbolic acid, creolin, or chloride of zinc, used in 
lotions or in baths, or by iodoform dressing, changed often. Should 
these be powerless to stop the invading march of the ulcer, the red 
iron has to be used. 

The therapeutics of Symptomatic ulcers is united with that of the 
affection to which they belong. In some cases, a local treatment is 
sufificient ; in others it is necessary to add to it an internal medication 
-{tonics, alkalines, arsenic.) 



FISTULA. 117 

V. 

FISTULA. 

Modern classifications of fistulge are based upon the etiology, patho- 
geny and anatomo-pathological characters of these lesions. We have 
congenital and pathological fistnlie, also fistulce from want of cicatri- 
zation and those from defective cicatrization. The most common con- 
genital fistulaj are those of the umbilicus, the urethra, and those 
which establish a communication between the rectum or the bladder 
and the vagina. Pathological fiistuhz include numerous varieties. We 
find the incomplete^ blind, or non-cotnmunicatiftg, and the complete or 
communicating fistulge. Blind fistulae are called idiopathic when they 
follow abscesses ; symptomatic when they result from other lesions ; 
they are externally blind when they open on the skin ; internally blind 
w'hen on the mucous tegument. Communicating fistulae include : i. 
Serous fistulce, which open deep down in one of the large visceral 
^cavities, in an articular or tendinous synovial sac, or in a natural or 
accidental subcutaneous bursa; 2. Mucous ?^s\.\x\^, which open in a 
reservoir or in a excretory canal. Generally, complete fistulas are 
cutaneous and itiucous; one of their openings is on the skin, the other 
on a mucous membrane ; they may be bi-mucous or bi-cutaneous when 
they have two openings on those membranes. 

The therapeutics of fistulae include numerous methods or means, which 
have their special regulations. It is plain that lesions, so various as to 
nature and origin, will require different kinds of treatment. Sympto- 
matic fistulas do not demand the same care as idiopathic fistulae ; with 
fistulas which opens in serous cavities, it would be dangerous to inter- 
fere as it is ordinarily done with those which open on a mucous mem- 
brane or in an excretory canal ; many of the latter require a special in- 
terference. 

Idiopathic purulent fstuhc, often kept up by the peculiar condition of 
their walls, by the atony of their granulating layer, sometimes by the 
sinuosity of their course, by the existence of subcutaneous or intra- 
muscular undermining, or by the excessive mobility of the organic 
layers of the region where they exist, do not resist a local energetic 
treatment. One may recognize the nature of the persistence of the fis- 
tulous tract by the more or less marked tumefaction of the region, the 
quantity and the quality of the pus, and by exploring the tract. If it 
be due to an undermining and kept up by frequent motions of the part, 
one may, after thoroughly washing the cavity, attempt a cure by pres- 
sure and immobilization of the region. But often the undermining: ex- 



Il8 VETERINARY SURGICAL THERAPEUTICS. 

tends far beyond the fistulous tract, or perhaps pressure cannot ba- 
applied. In such cases, the rule is to make a counter-opening in the 
most dependent part so as to allow and complete the escape of the 
pus through a drain tube. Whether there is undermining or not, if the 
fistulous tract is old, organized, and lined with an epithelial layer, cica- 
trization cannot take place without destroying this superficial covering 
and stimulating an active granulating process. Injections, the seton 
and cauterization fulfil all these requirements. A great number of 
therapeutic agents have been used in injections to stimulate the granu- 
lation of fistulas ; among them metallic sulphates, tinctures and anti- 
septics in concentrated solutions. The most desirable of these are the 
Villate solution, the tincture of iodine, the alcoholic solution of corrosive 
sublimate, the aqueous solution of chloride of zinc (S-io c;) and of car- 
bolic acid (5ff). If cicatrization is slow, it is wise to change the injec- 
tions. In cases where these fail, solid caustics may be introduced into 
the fistulae : minium troches, pencils of nitrate of silver, paste of sub- 
limate or of chloride of zinc. With obstinate bicutaneous fistula?, the 
introduction into the tract of tents or small setons, impregnated with 
irrigating caustic or vesicating preparations (Villate solution, tincture 
of iodine, spirits of turpentine, blister ointment, basilicon, or iodide of 
mercury ointment), is good practise ; when it is necessary to introduce 
several tents, they should be made small, so as to not interfere with the 
granulations. Cauterization of the tract of old fistulae with the hot 
iron is an old, severe, but certain mode of treatment. It is done with 
a blunt probe or a metallic wire of small dimensions; the narrow and 
blunt point of the zoocautery is very good for short tracts. In some 
cases, it is advantageous to have recourse to incision, and curetting 
of the tract. Incision assists cicatrization of fistulae with several 
tracts. The callosities existing on the walls of old fistulous canals gen- 
erally require to be removed with the bistoury or with the curette. 
.Some of these fistulae require special operations ; for instance, that 
■which is present in cases of keraphyllocele, is relieved only by the ex- 
tirpation of the horny growth. 

The treatment of symptomatic fistuhe depends on their causes, and 
the conditions of their presence. Some are due to the presence of a 
foreign body or a necrqsed, loose piece of bone ; they are recognized 
by the pus which flows from them, not very abundant, or unpleasant 
in nature. They heal rapidly after that which causes them is removed. 
To do this, one has only to enlarge the size of the tract, take hold of 
the irritating object and extract it. Most of these fistulee are the 
expression of a necrotic lesion involving a bone, a cartilage, a tendon, 
a ligament or an aponeurosis ; they secrete abundantly a grayish, 
watery pus, often grumous and carrying small pieces of necrosed 
structure. Generallv, the seat of the wound, the extent of the indura— 



FISTUL.-E. 119 

tion, and the probing allow one to detect the exact nature of the existing 
lesion. The treatment varies according to cases. At times, simply a 
larger incision, and escharotic injections are all that is required ; at 
others, to stimulate the action of the caustics and permit the free escape 
of the pus, one or several counter-openings have to be made, and 
drainage tubes inserted ; at other times, if the necrotic lesion is super- 
ficial, especially in cases of a bony alteration, it is better to dry off 
immediately the source of the suppuration by removal of the mortified 
part. Care should be taken that the pus be not in contact with tissues 
with sluggish nutrition, since they offer an easy prey to pyogenic 
tnicrobes. Cauterization of the diseased center, a method borrowed 
from old hippiatria and brought down to our own times, is far inferior to 
immediate extirpation ; it leaves an eschar, which sloughs off slowly ; 
and in fibrous tissues a new focus of necrosis may be the result of the 
extensive suppuration that follows. In horses and in cattle, sometimes, 
the product of the secretion of fistulous walls dries and forms in the 
tract a cylindrical, hollow, foreign body, which keeps up the suppura- 
tion. We have just seen a remarkable case of this nature in an 
animal suffering from an old fistula of the flank. 

Of serous fistula, some get well quite rapidly by the division of the 
tract and by simple antiseptic injections ; those of serous bursas and 
small tendinous sheaths, belong to the same group. But fistulous 
tracts which open into large tendinous or articular synovial membranes 
are very serious in animals, on account of the difficulty of thoroughly 
disinfecting those cavities : in former days, injections of CEgyptiacum, 
a direct cauterization of the walls with a red iron or with nitrate of 
silver, were recommended for these. To-day antiseptic treatment is 
preferred. (See Articular Wounds and Arf/iritis.) Fistulae of the large 
serous membranes are very rare ; they are observed only where the 
traumatisms which precede them have given rise to a circumscribed 
phlegmasia of these membranes and to the formation of adhesions which 
bound the suppurating serous territory. Antiseptics are used for these 
cases. Very recently, a strong carbolic acid solution has given us rapid 
recover}' in a case of vagino-peritoneal fistula following an operation of 
ovariotomy on a mare. 

We shall be concise in speaking of the treatment of mucous fistula;, 
and will return to it when we study these lesions in particular. Of these 
fistula;, those which are kept up intentionally by a foreign body have a 
well-marked tendency to cicatrization. 'I'lie muco-cutaneous fistulae of 
the sinuses, following trephining, close in a few days by the removal of 
the corks or drains which keep them open; those of the trachea heat 
in the same way when the tube of tracheotomy is taken away. If those 
that are due to dental caries or to suppurative alveolitis require a long 
time to heal after the extraction of the diseased tooth, it is due to the 



120 VETERINARY SURGICAL THERAPEUTICS. 

slow process of the phenomena of the existing osteitis and to the accu- 
mulation of food and saliva in the alveolar cavity. Some oesophageal 
fistulae are obstinate and require surgical interference. As to the recto- 
vaginal and the vesico-vaginal fistulas, attempts sofar made with animals 
to bring about cicatrization have only proved unsuccessful. 

There are fistulae of excretory canals which naturally have a ten- 
dency towards cicatrization : those of the perineum after urethrotomy, 
for instance. But almost all of them require a special treatment. 
There are three principal methods to be used : i. Restore the normal 
course of the flow ; 2. Create an artificial one ; 3. Dry its source. 

If the fistula is recent, one may resort to the first method ; applica- 
tion on the fistulous orifice of a closing bandage, vesicating frictions, 
light and repeated cauterization of its edges, dilatation of the canal by 
injections or by repeated uses of the sounds and the like. Occlusion, 
vesication, and suture have often been used for recent salivary or urethral 
fistulae. The second method is applicable only to a small number of 
cases ; it is especially advised for a fistula of steno duct, open on the 
cheek. To make a new way and dry the cutaneous fistula, the deep' 
layers of the cheek, including the buccal membrane, are perforated on 
a level with the wound, which is then closed by suture or a pitch plaster ; 
the saliva escapes then into the mouth and transforms the newly-made 
tract into a fistula. Success is still more certain if the new tract is. 
drained while the old one is obliterated. The last method brings on 
recovery in cases of fistula by producing the atrophy of the gland. For 
certain salivary fistulae, irritating injections made in the parotid gland 
and the ligature of the excretory duct have been successfully employed.. 

Purulent, stercoral, and vesical fistulae are quickly followed by- 
erythema of the parts soiled by the substances escaping from them.. 
In their neighborhood, the skin ought to be washed several times a 
day with a weak, tepid, antiseptic solution, and covered with boricated 
vaseline or glycerine. 

For some subjects, it may be useful to institute an appropriate general 
treatment. Good food and tonics are always advantageous for debilitated 
animals, weakened by an abundant suppuration of long standing. 
For certain fistulas of the dog, an internal medication is advised (Fowler 
solution, Cod Liver Oil). 

VI. 

FOREIGN BODIES. 

Among the foreign bodies to be found in animals, some are formed' 
in the organism under the influence of morbid processes (splinters,, 
sequestra, calculi, pedunculated tumors of the peritoneum), but most 
of them have come from outside, having penetrated the organism either 



FOREIGN BODIES. 121 

through natural passages or through the skin or a mucous membrane. 
The last are those which we shall specially consider. 

The phenomena produced by foreign bodies vary considerably 
according to the degree of tolerance of the tissues with which they are in 
contact, and especially according to their more or less irritating 
properties, and their septic or aseptic constitution. 

The digestive canal is the principal way for the introduction of 
foreign bodies, and its mucous membrane is one of the most hospitable. 
Among the substances which enter the mouth, some stay in it, implant 
themselves on the gums, the cheeks, or the tongue, and give rise to 
abscesses (Huchne, Dehaye). Others perforate the walls of that cavity : 
in an abscess of the hollow of the right eye, Lapousse'e found a mass of 
beards of wheat ; in a similar spot, Klintmann saw small pieces of straw. 
The nervous centers have sometimes been reached by those emigrating 
substances which run through the walls of the mouth and of the 
pharynx : at the post mortem examination of a horse, Rodez and 
Kenard found the cranium perforated by a stalk of grass ; in a pig, 
Durrechou observed an intra-cranial abscess caused by a needle ; at the 
autopsy of a dog having died from meningo-encephalitis, we have seen,, 
with the lesions of that disease, a deep, suppurative otitis due to a 
metallic piece, which, after perforating the soft palate, had entered the 
Eustachian tube. Larvce of cestre' can produce similar disorders. 
(Megnin). 

Most foreign bodies introduced into the mouth pass into the pha- 
rynx and the oesophagus ; sometimes they remain there : Me'tivet 
treated a horse whose throat was closed by a piece of wood ; the 
cesophageal obstruction of cattle is well known. Some of these bodies 
drop into the trachea (Degive, Bournay). Those which reach the 
stomach have varied fortune. They may remain there without producing 
visible trouble : this fact, very ordinary in ruminants, is known in all 
species of animals : at the post mortem examination of a mare which 
had died suddenly, Garde found in the stomach seventy-five little stones 
weighing altogether 4 kilogrammes (8 pounds) ; Nichoux found in a dog 
a five-franc piece and one two-cent piece, which had remained in the 
stomach twelve years without apparent trouble to the dog; in an 
animal of the same species, we found two tops which had been in the 
stomach eleven months. Some of these bodies give rise to dyspeptic 
symptoms: in ruminants, to meteorizations ; in dogs, vomiting followed 
by anorexia and loss of flesh. Ordinarily the dog succeeds in throwing 
up the foreign body accidentally swallowed. Weber has related the 
case of a dog thus rendering one morning " a gold piece of twenty 
francs and two silver fifty centimes." When the substance swallowed 
is not too big, it may pass through the pylorus, travel through the 
intestines and be eliminated : the horse of our Belgian confrere Andre, 



122 VETERINARY SURGICAL THERAPEUTICS. 

passed a curb-chain which he had swallowed ; the dog of which a report 
was made by Leblanc, passed a stone of large dimensions ; that of 
INIathis, after violent fits of colic expelled " the cork of a champagne 
bottle.'' When the dimensions are too great, the foreign body is 
arrested, and may give rise to rabid symptoms ; the phenomena, 
however, of deep depression generally predominate. If the body 
become encysted, it soon produces severe inflammation and sphacel of 
the intestinal walls, if it is not removed by laparotomy. (Noirit, 
Felizet, Degive, Frohner).* 

Sharp bodies, when introduced into the digestive canal, end by 
implanting themselves in its walls and pass through them more or less 
rapidly. Passing through the oesophagus, they may injure the anterior 
aorta (Olivier) or the posterior (Daigney), give rise to an aneurism 
(Olivier), or to a fatal hemorrhage. In ruminants, they pass through 
the rumen or the reticulum, and, according to the direction they take, 
reach the liver, the spleen, the abdominal walls, the diaphragm, heart, 
lungs, muscles of the shoulder or of the arm, the vertebral column, and 
even the spinal cord. A foreign body is the common cause of traumatic 
pericarditis of cattle. Guillaumin, Robinson, Aubry, Mottet, Lanusse, 
Berger, Bru, Morot, Lucet have recorded abscesses of the thorax or of 
the abdomen, due to the presence of foreign bodies which have been 
swallowed. The cow which served Mottet for a subject of observation 
swallowed two long needles ; the eighteenth day, the point of one 
appeared under the skin of the middle of the right flank ; a week later, 
the other showed itself near the last left rib ; the animal seemed scarcely 
disturbed by them and the wounds healed rapidly. Rupture of the 
intestine (Clerc and Jacotin), abscesses of the omentum (Salle), or of 
the liver (Thierry), and peritonitis, also represent possible complications 
of foreign bodies passing through the digestive canal. An autopsy of a 
horse, made by Salle, revealed an epiploic tumor ; and in the center was 
a cavity filled with pus, in which floated a "string 25 centimeters 
long." 

The 7'aginal mucous membrane possesses a certain amount of tolerance ; 
the mucous membranes of the uterus, bladder and urethra are more 
irritable ; metallic substances, however, introduced into the uterus to 
overcome nymphomany (filoire) are perfectly supported. As to the 
ocular and respiratory mucous membranes, they always react strongly 

* From records of the Hospital Department of the American Veterinary College, 
Drs. Huehne, and Morrison report the case of a dog in which the foreign body was 
imbedded into the pyloric opening of the stomach. It consisted of a ball of brown 
paper tightly rolled. (Americ. Veter. Review. Vol. 13 — p. 175). (T) 

At X\ie. post mortem examination of a cat that had been ailing for some time without 
manifest symptoms, a piece of the cob of an ear of corn was found imbedded into 
the pyloric opening of the stomach by the translator. 



FOREIGN BODIES. 1 23 

against irritating contacts. At \\\q, post mortem examination of a dog 
affected with severe wheezing, and short and repeated coughs, 
Bournay found under the vocal cords "a small, oval, flattened piece of 
gravel, which completely closed the trachea." 

Cellular, fibrous, muscular, and glandular tissues react little against 
the contact of foreign aseptic bodies. Frequently shots, bullets and 
ether bodies of some size produce only the phenomena of encystment. 
Projectiles of small caliber may thus remain in the tissues for years with- 
out producing any trouble ; then again they may give rise to accidents 
after remaining innocuous for some time. A ball encysted in the hand 
of the man wounded at Waterloo, mentioned by Harland, after fifty- 
nine years of perfect tolerance, gave rise to disorders (Terrier). In- 
fected inorganic substances (wood, leather, etc.) ordinarily bring on 
severe inflammation. 

Bones will stand metallic substances of small size without perceptible 
reaction. Encystment, however, is more commonly observed in long 
than in flat or short bones ; and in the former, more in the epiphysis 
than in the diaphysis. When there are other bodies than projectiles 
or metallic points, then often the bone becomes inflamed, suppurates, 
and serious consequences are to be feared. 

The disturbances produced in viscera by foreign bodies depend also 
on the properties of the bodies and the degree of irritability of these 
organs. If certain regions of the brain (hemispheres, white commis- 
sural portions) are remarkable for their tolerance, in general the ence- 
phalon, the marrow, and the nerves do not support the contact of 
foreign bodies. The patients of Renard and of Durrechou died from 
a cerebral abscess. Encystment is possible in the spleen and the liver ; 
it is quite frequent in the lung, where, as in all viscera, one may, how- 
ever, observe primitive or secondary accidents very serious. 

Serous membranes possess a remarkable tolerance towards bodies 
formed spontaneously in their cavity (intra-articular movable bodies, 
pedunculated tumors of the peritoneum) ; they support equally well the 
contact of aseptic foreign bodies, but they are extremely susceptible to 
those that are soiled, and more or less septic ; and the action of the 
latter invariably gives rise to an inflammation rapidly generalized. 
Although the peritoneum may ordinarily be run through by free needles 
without accident, it becomes the seat of an infectious diffused phlegmasia 
in contact with a needle carrying a soiled thread. There is the same 
order of phenomena and the same differences for wounding bodies 
(septic or aseptic) which, after divisions of the abdominal or tlioracic 
walls, reach the peritoneum or the pleura. Kolb has found in the right 
ventricle of the heart of a cow, a lancet blade three and a half centime- 
ters long by two in width, which had become loose during a bleeding 
of the jugular and had been carried away by the current of the blood. 



124 VETERINARY SURGICAL THERAPEUTICS. 

This blade had remained in the heart without giving rise to the slightest 
trouble. Articular or tendinous synovial membranes behave like the 
serous membranes of splanchnic cavities. 

The tolerance of the media of the eye is also especially related to the 
aseptic or infecting condition of the body which has penetrated them ; 
the iris, vitreous humor, and the retina, however, are more susceptible 
than the crystalline lens and the serous membrane of the anterior 
chamber. 

In the foot of the horse, foreign bodies produce, almost always 
rapidly, serious troubles, on account of the complex structure of that 
organ, of the ordinarily infectious character of the traumatism, and of 
the compression to which the injured parts are submitted. 

Animate foreign bodies produce very different effects, according to the 
species, the number, their properties and the tissues upon which they are 
fixed. How many intermediate degrees can be observed between the 
weak reaction of the stomachal mucous membrane of the horse from 
cestri, and the intolerance of the nervous centers towards the parasites 
which are carried to them by the blood. 

To liquid foreign bodies the susceptibility of the organs is no less 
variable. No serious troubles result, ordinarily, from the introduction 
of serosity poured into closed traumatic lesions. Liquids, aseptic and 
not toxic, injected under the skin, into muscles, serous membranes or 
blood-vessels, are also well supported. But the tissues are very suscep- 
tible to the contact of some organic liquids obtained from their natural 
canals (urine, bile, saliva). The escape of bile, or of urine, into the 
peritoneum is often fatal. Medicamental solutions injected without 
sufficient aseptic care, ordinarily bring on suppuration or other infec^ 
tious accidents. The contents of hydatic cysts and of all morbid secre- 
tions, generally speaking, are badly tolerated. 

Gases, considered as foreign bodies, offer little interest. All are 
harmless, except those that possess toxic properties, and are tolerated 
by the tissues without trouble. The benignity of traumatic emphysema, 
even when it is more or less generalized, is well known. Phenomena 
of intolerance are observed only when gases hold infectious agents in 
suspension. 

The therapeutics of foreign bodies presents very different require- 
ments, according to their nature, their size and their aseptic or infectious- 
state. The preceding considerations show the relative innocuity of 
metallic bodies compared with organic substances, and the remarkable 
tolerance of the tissues for the former, when they are small and aseptic. 
The organism does not try to get rid of them ; it only defends itself 
against contact with them ; it isolates them with a circular neoformation 
resulting in an encysting membrane. No immediate interference is 
necessary for those, unless they are so nearly on the surface that theic 



FOREIGN BODIES. I25 

extraction offers no serious difficulty. Leave the work of encystment 
and watch the progress of the changes. It is in conformity to this rule, 
that little projectiles and other metallic bodies are left in the tissues. 
Penetrating wounds should not be explored with dirty instruments or 
fingers. Cut the hair round the traumatism, disinfect it with free an- 
tiseptic irrigation, cover it with iodoform, collodion, and, if possible, 
with a wadding dressing. Such are the regulations to follow. Extrac- 
tion is advised only for projectiles immediately under the surface of the- 
skin, and requiring only slight incision. If the foreign bodies are pro- 
truding from the surface of the skin, they must be removed immediately 
with all necessary care, and the wound must be treated like those result- 
ing from punctures. (See GuJi Shot Wounds zwA Wounds h^^^ Pricking In- 
struments. ) 

More or less soiled foreign bodies, introduced into any region and 
situated superficially, are extracted with forceps after the disinfection 
and division of the tract which they have made. The interference is 
the same for similar bodies lodged deeply in a muscular region — neck, 
shoulder, croup, or thigh — where only important blood-vessels and 
nerves are to be avoided. Abscesses produced by foreign bodies which 
have run through the mucous membrane of the mouth, pharynx, oeso- 
phagus, stomach, or intestines, and have migrated into the tissues, do 
require special attention. Whether situated on the head, neck, thorax, 
or abdomen, as soon as fluctuation is manifest, they must be punctured, 
the injuring body extracted, and antiseptics applied. For those which 
appear on the thoracic or abdominal walls, the diagnosis is sometimes 
difficult. 

Generally, the cicatrization of the tract made by the foreign body 
takes place quickly. It may, however, leave a fistula. After extract- 
ing a pair of scissors from an abdominal abscess in a steer, Berger 
found that the wound extended to the rumen (see Intestinal Fistulic). 
Some fistulas, not in communication with a mucous membrane, may be- 
kept discharging by the presence of a second foreign body held in the 
tissues, or by a piece of the first. 

Foreign bodies which, after remaining some time in the tissues, give 
rise to a superficial abscess, require also that the abscess shall be punc- 
tured, and that they shall be extracted. 

Animate foreign bodies demand special treatment. The ticks of 
the dog are removed by the simple touch of a piece of cotton moist 
with benzine. Linguatulina are made loose by nasal douches of 
cresyl solutions, ammonia, or benzine ; from the connective tissue of 
cattle and horses hypoderms are extracted by squeezing. The para- 
sites of the digestive canal are expelled by anthelminthics and purga- 
tives ; those of the respiratory apparatus by fumigations of tar. 

Aseptic liquids gathered in cavities existing inside of tissues may be 



126 VETERINARY SURGICAL THERAPEUTICS. 

absorbed rapidly, or, on tlie contrary, remain there witliout sustaining 
any sensible change. Often, by allowing their escape, the duration of 
treatment is much shortened. Modified physiological fluids and some 
pathological collected in the tissues or in natural cavities ought to be 
evacuated at once. A severe antiseptic treatment should follow. 

As to gases, they are generally absorbed by degrees or eliminated. 
According to the case, they are left alone (expecting treatment), or 
their expulsion is stimulated by massage, or an outlet is opened to 
them by puncture. 



CHAPTER II. 

SECTION I. 

TRAUMATIC LESIONS. 

The old division established for traumatic lesions must be retained 
■when they are considered from the point of view of their mode of re- 
pair and of the therapeutical measures they require : thus we recognize 
external, open or exposed traumatic lesions, in which the teguments — 
skin or mucous membranes — are divided ; and internal, subcutaneous, or 
interstitial lesions, which are without solution of continuity of the skin 
or internal mucous membranes. Both kinds may open in pre-existing 
cavities or in natural reservoirs or canals ; then they are called 7vounds 
of cavities (plaies cavitaires), and are divided into external and internal. 

All traumatic lesions offer for consideration in its walls three zones : 
I. A 7nodified ox gatigrcnous zone, whose existence is constant but extent 
variable. At times, when it is very limited, and represented by little 
necrobotic parts or reduced to the thin layer of the anatomical ele- 
ments, which have directly received the action of the disturbing body 
(cuts, pricks), it does not prevent immediate reunion ; at other times, 
when it is very extensive, is formed of crushed tissues, and infil- 
trated with blood and serosity, in which the blood-vessels are de- 
stroyed, severe complications are to be expected, 2. A zone called 
stupefied {stupefiee) or ischcemic, which surrounds the preceding, and in 
which the tissues have lost their vitality, a zone in which the elements 
can recover their activity quickly, but which, on the contrary, becomes 
easily a prey to gangrene if severe phlegmasic phenomena occur. 3. A 
zone of irritation, peripherical, which is going to be the seat of great 
hyperemia, exudation, and leucocytic immigration more or less 
abundant, where began the changes leading to the separation of the 
wound, and from which start those which complete it (Verneuil). 

These complex phenomena which accompany traumatic lesions show 
peculiarities which depend upon numerous causes ; upon their exposure 
to the air or the protection of the wound by the tegumentary mem- 
brane, upon their extent, their depth, the nature of the involved struc- 
tures and the seriousness of the hurt they received ; upon their aseptic 
state or the interference of pathogeneous micro-organisms, and also 

127 



128 VETERINARY SURGICAL THERAPEUTICS. 

upon the constitution of tlie patient, the diathesis or the organic affec- 
tions he may have. 

In veterinary medicine but little is known of the modifications made 
upon traumatisms by infectious and general morbid states, or of the 
mutual influence these have upon each other. Numerous facts, how- 
ever, seem to show that it is the same with animals as with man. Max 
Schiiller, in experimenting with rabbits, has shown the influence of 
traumatisms upon tuberculous manifestations, thus elucidating the 
pathogeny of bacillar arthritis. In animals which have had disorders 
of a rheumatic nature, traumatism may give rise to new localization 
or to an excitement of the diathesis, especially of articular inflamma- 
tions, when it exists close to a joint. Reciprocally, in those animals, 
one may observe after wounds some unusual phenomena. In certain 
patients, under the influence of a cancerous diathesis, a traumatism 
may develop a cancer in the injured region. In general, the progress 
and the cicatrization of wounds do not seem to be influenced much by 
carcinosis as soon as the organism is not below par ; we see quite 
often, in dogs, wounds after the removal of cancerous growths, healed 
rapidly without relapse loco vubierato ; but when carcinosis is old, on 
the road to generalization, and has brought on cachexia, traumatic 
lesions are repaired but slowly, and often accelerate the progress of 
propathy. It is the same in cases of sarcomatosis. One of us has re- 
lated the case of a dog having a sarcoma on the head of the femur, in 
which the generalization of neoplasia took place rapidly, after a needle 
cauterization upon the primitive growth, the nature of which had re- 
mained unrecognized. In diabetic patients the tissues are not only 
impregnated with sugar, but they are also altered in their nutrition : 
spontaneous ulcers may develop themselves, as has been seen in dogs. 
These ulcerations and all accidental traumatisms predispose to gan- 
grenous and septic accidents. On the other hand, it has been known 
for a long while that certain traumatisms give rise to diabetes : such as 
wounds of the heart and of the superior part of the neck, which drive 
back the cephalo-rachidian fluid and secondarily bruise the floor of the 
fourth ventricle (CI. Bernard) ; serious lesions of the vertebral column, 
or violent contusions of the thorax and of the abdomen, which bring 
with them functional disturbances in the pancreas or the liver. Albu- 
minuric subjects when wounded are predisposed to cedema, phlegmon- 
ous inflammations and to suppurative lymphangitis and adenitis. With 
them traumatic hemorrhages are ordinarily abundant, and secondary 
hemorrhages frequent ; with these, also, wounds assume frequently an 
ulcerative character or become complicated with diffuse phlegmons or 
with gangrene. It is known that large suppurating wounds, and bony 
.lesions in particular, may give rise to renal lesions (infectious ne- 
phritis) followed by albuminuria. In subjects affected with hemophilia 



TRAUMATIC LESIONS. I29 

or leuchaemia, slight traumatisms are often accompanied by consider- 
able hemorrhages, which are sometimes fatal ; in dogs affected with 
ganglionary leuchaemia (adenie), the extirpation of a single ganglionary 
mass is followed by abundant hemorrhage, very difficult to stop. Trau- 
matisms of operations, or those that are accidental, may be followed by 
inflammatory or septic complications. 

Among visceral diseases, affections of the heart give rise to a circulatory 
trouble which may produce dyspnoea, oedema, ascites, or hydrothorax. 
On that account the wounds of patients affected with these bleed pro- 
fusely ; sometimes, besides, there are vascular alterations. Qidema, 
which occurs in patients affected with heart disease, expose them, as in 
those affected with albuminuria, to erysipelas and to phlegmons. In 
patients with heart-affections, traumatisms may bring on phenomena of 
asistole. Diseases of the liver (cirrhosis, fatty and amyloid degeneration) 
carry with them numerous disorders — interference with the circulation, 
-digestive troubles, alteration of the blood — which have a great influ- 
ence on the progress of the traumatisms. These become the seat of a 
hemorrhage difficult to stop, and of diffuse inflammation ; they are 
often accompanied by erysipelas, lymphangitis, profuse suppuration, 
and these predispose to pyohasmia and septicaemia. Traumatisms are 
Tiot without influence upon the evolution of hepatic affections; they 
may stimulate in them a sudden aggravation. 

Finally, all acute diseases, accompanied with intense fever, and in 
particular infections, act on traumatisms and interfere with the repair- 
ing process. Let us also mention as such, age, species, breed. 

Traumatic lesions of diseased tissues present some peculiarities and 
expose them to complications which vary according to the alterations 
of those tissues. In hyperaemic parts or those affected with acute in- 
flammation, hemorrhage is always abundant, and the cicatrization by 
first intention rare : complications of diffused inflammation, phleb- 
itis, lymphangitis, are frequent. Wounds of suppurating surfaces ex- 
pose the patients particularly to erysipelas, lymphangitis, pyohaemia 
and tetanus ; therefore, as far as possible, one should avoid injuring 
those wounds. When traumatisms involve tissues already altered by 
chronic inflammation, the consecutive phenomena are sometimes nearly 
like those which take place in sound tissues ; at others, one will notice 
a return of the phlegmasia to an acute stage, the suppuration increas- 
ing, after which recovery takes place ; then again the wound may 
assume an ulcerative character. 
9 



;30 VETERINARY SURGICAL THERAPEUTICS. 



WOUNDS FROM SHARP OBJECTS (INCISED WOUNDS), 

Whether wounds arise from the operation or from ctccide/if, immediate 
union is possible ; and one should try to obtain it. The conditions for 
cicatrization are known : clean, regular or recent wounds ; edges smooth, 
of goodnature, without indication of mortitication ; perfect hemostasis; 
exact and entire adaptation of the surfaces ; absence of foreign sub- 
stances ; above all, no infectious elements in the wound ; protection of it 
with a dressing ; and, finally, freedom of the wounded from diathesis or 
any other morbid state likely to influence the wounds unfavorably. The 
edges of wounds from sharp instruments are, in general, but little 
altered, easily adapted throughout their whole extent, are not ragged or 
irregular, and are without loss of tissues endangering vitality. 

Loss of substance which is not extensive does not prevent imme- 
diate union ; but the regular juxtaposition of the edges is more dif- 
ficult, and their tension by the sutures is an unfavorable condition. 
Accidental cuts sometimes have borders more or less bruised and 
ragged; they will be cleansed with the bistoury before being brought 
together. If a thin clot of blood interpose between the edges of the 
wound, it will be absorbed after they have been brought together ; if, 
by it, the union of the surfaces is only made slower, and large clots 
separate these surfaces mechanically, they constitute a favorable soil 
for the micro-organisms lost in the wound, and, besides, facilitate the 
purulent destruction. 

If the wounds are aseptic, all that is necessary to obtain adhesive 
union is to avoid all contamination. It is useless to inundate them, as 
is still done so often, with strong bactericide solutions, which irritate 
and necrose the anatomical elements of the superficial la3er of the 
edges. Boiled water is sufficient for these. For such as have been 
soiled with the instrument or the cutting object, with the hairs, dust^ 
straw, manure, or mud, antisepsis is necessary, and strict cleanliness 
indispensable. The edges of the wound are still well nourished, the 
anatomical elements have still their activity, the leucocytes come 
rapidly to strengthen the defence ; but these favorable conditions are 
not sufficient to prevent infection by the staphylococci, streptococci, 
tetanic or septic spores. After these wounds have been badly dressed, 
one often sees tetanus or septicaemia make its appearance. In such 
cases, a simple disinfection with any antiseptic liquid is not sufficient;. 
strong solutions and copious irrigations are necessary. 

When the region is not prepared, the skin of the peritraumatic region 



WOUNDS FROM SHARP OBJECTS. 131 

should be shaved and disinfected ; then the raw surfaces should be 
purified as indicated. 

The condition of the wound justifies the attempt to have immediate 
union. If the blood fiows yet in abundance, and in streams, it can be 
stopped by affusions of cold boiled water; if it escapes from a large 
blood vessel, a small vein or artery, hemostasis should be made with 
one or several catgut ligatures, which will be absorbed. The ends of 
the catgut should be cut close to the stopper knot ; and there the 
edges of the wound should be brought close together, and held in posi- 
tion by sutures, carefully placing in coaptation the similar portions of 
the two juxtaposed-surfaces. Sutures with close stitches made of silk 
threads, or silk-worm gut, are preferable to metallic sutures. With 
deep wounds, the mortified parts should be avoided, by adding deep 
sutures made with catgut to the superficial. These deep sutures will 
hold the edges of the wound close together, in their entire thickness, 
for a length of time sufficient to permit adhesion to take place, \^'e 
■will mention, merely for the sake of calling to memory, the sticking 
bands and uniting bandages, all of which are inferior to sutures and 
are therefore left aside. According to the region, the wound should' 
be closed with iodoform collodion or covered with a wadding dressing, 
after having been powdered with iodoform or with a coat of iodoform 
vaseline. When once the union is obtained, the sutures not absorbed 
should be removed. 

In wounds with exeresis, interrupted suture has the inconvenience 
of producing on the edges too severe a tension ; and often the tissues 
are cut by the stitches. Twisted suture holds the borders of the wound 
close together and is advantageous for solutions of continuity which 
divide entirely the walls of natural openings or of some delicate struc- 
tures (lips, nostrils, false-nostrils, eyelids, or sheath). When the 
dieresis involves deep down an aponeurosis, a tendon or a bone, a 
tendinous sheath, a synovial membrane, one of the great serous struc- 
tures, or one of the visceras they contain, in general, immediate treat- 
ment does not present other difificulty than a minute antisepsis and 
occlusion. 

If adhesive reunion has failed, and the wound suppurates, it should 
be disinfected with a strong antiseptic solution (corrosive sublimate i in 
jooo, creolin or carbolic acid 4 or 5 ^c, chloride of zinc 8 or 10 fc) or with 
atomizing or baths of a less concentrated solution ; it should be covered 
with a dressing, or left exposed. Experience has shown the superiority 
of these agents over alcohol, camphorated alcohol, or tinctures, even 
those of arnica or glycerine. To assist the escape of the pus is a 
principle which is more strictly followed to-day than ever before. At 
times, it is necessary to drain the part with a fenestrated tube fixed to 
the borders of the wound by a stitch of suture ; when the wound is 



132 VETERINARY SURGICAL THERAPEUTICS. 

partly filled with granulations, the drain is removed. With deep sup- 
purating solutions of continuity of the superior regions of the body, free 
incisions or counter-openings are often required. 

A simpler treatment, used for numerous superficial wounds, consists 
in washing them several times a day with salt and water and covering 
them with absorbing or antiseptic powders (those of coal, coal-tar, 
camphor, tannin, alone or mixed with iodoform). But until these 
wounds are entirely covered with a coat of granulations, infectious com- 
plications are to be feared. The surest way to prevent them is to make 
a free use of microbicide solutions. 

II. 

WOUNDS FROM PRICKING OBJECTS. (PUNCTURED 

WOUNDS). 

The gravity of these depends especially upon the tissues or organs 
that are involved, and upon the size, form, and aseptic or infected state 
of the injuring object. Pricking bodies with sharp points, fine and 
smooth edges, penetrate while separating the anatomical elements, 
which are destroyed in small number only, and the phenomena fol- 
lowing are simple. The innocuity of exploring punctures made with 
trocars or needles of small dimension is well known, there is a like 
simplicity of phenomena following subcutaneous operation, wounds 
which have decided analogies with pricks from two points of view — the 
way they occur, and their character and mode of repair. Let us recall 
again to memory the cases where people have implanted a number of 
needles deeply in certain regions, without any accident following. It 
is also known that needles, unthreaded, which are swallowed, can pass 
through the walls of the digestive tube and travel through viscera with- 
out doing any serious mischief ; in dogs and cats, it is not rare to find 
encysted in viscera or in the tissues, needles whose presence was never 
suspected on account of the absence of all pathological manifestations. 
It is very different when the needle carries a thread, since it bears with 
it infectious elements which give rise to septic complications. 

If larger points, conical or prismatic, enter also the tissues and 
separate their elements, they compress them more, and easily lacerate 
them. Bodies with blunt or ragged points, those whose edges are 
rough, bruise and lacerate the organs, and make a lesion with contused 
walls and an irritated zone which may afterwards mortify. The wound- 
ing agent may open a vein, an artery, a synovial sac, or one of the 
great serous membranes, and may break into the tissues. Often it is 
soiled and loaded with pblogogenous or septic germs, so much the more 
serious as the tissues are more delicate. Infected pricks of aponeuroses, 
ligaments, tendons or bones, ordinarily, are followed by limited necrosis 



WOUNDS FROM PRICKING OBJECTS. 1 33 

of those organs. Penetrating wounds of tendinous sheaths, of articular 
synovial sacs, or of splanchnic cavities, are, ordinarily, accompanied 
with diffused inflammation of those membranes. Complications of 
tetanus and of septicaemia are likely to be fatal where the agents of 
these serious infections are deposited in the punctures (wounds with 
stable forks, with the tooth of a harrow, or with a nail). 

Wounds from prickings when free from infection heal rapidly. 
Immediately after the extraction of the wounding object, the sepa- 
rated tissues return close to each other. The narrow solution of con- 
tinuity is soon filled with plastic lymph, with leucocytes, and with pro- 
liferating elements, and cicatrization is a matter of a few days. All 
that is required is to assist the repairing process. Clip the hairs all 
round the prick, disinfect the tegument and the edges of the wound, 
close it with iodoform collodion ; such are the rules to be observed. The 
same treatment should be used for pricks made with points of larger 
dimensions, which contuse and bruise a thin layer of the tissues pierced, 
but do not carry with them infectious elements. Rapid occlusion is 
especially important with penetrating wounds which open an articular 
serous membrane, the pleura, or the peritoneum. The old treatment, 
■which consisted in finding out, by probing, the depth and direction of 
those wounds, to enlarge them or enlarge their sides, is now condemned. 
To wait for developments is the rule, even when the wounding object 
has been broken and has left its point in the tissues: if it is aseptic, 
only a light reaction will follow, and it will become encysted. Exam- 
ples are common of pricks, which look serious at first, but heal with- 
out complications. The same is true of the numerous penetrating 
wounds of a horse's foot, although made by soiled substances, which, 
however, in piercing the hoof, have been relieved of the impurities de- 
posited on their surface. 

Infected punctures are not slow to give rise to acute pains accom- 
panied with great tumefaction of the wounded region. These manifes- 
tations are treated with antiphlogistics, continued irrigations, especially 
with antiseptic baths or nebulizations. If the lesion is on the extremity 
of a leg, one will have recourse to repeated immersions in a carbolic 
acid, a cresyl or a luke-warm corrosive sublimate solution. Some- 
times the inflammatory manifestations subside, at others they remain 
or increase, pain becomes excessive, and tumefaction diffuse ; then, 
most commonly, either pus collects at the bottom of the wound, or tlie 
inflamed tissues are compressed by an aponeurosis, or an irritating 
foreign body remains there implanted. At this point one should inter- 
fere at once. Without loss of time the first puncture should be freely 
enlarged, in order to allow the pus to escape, if there is any, the 
phlogosed tissues should be relieved, and the irrigations or the antisep- 
tic baths should be continued. The enlarging: of the wound assists the 



134 VETERINARY SURGICAL THERAPEUTICS. 

resolution of the inflammatory process, and allows the elimination of 
the foreign body which may have been retained. Even w'hen the 
jDhlegmatic phenomena are intense, it is better to wait for this spon- 
taneous elimination than to make with probes and forceps attempts and 
explorations which are always very painful and without real usefulness. 

In small animals, wounds are often observed which were made by 
curved pricking objects (hooks of any kind) still implanted in the tis- 
sues. These objects must be removed by enlarging the opening of 
their entrance, or by pushing them through the tissues and extracting 
them by their points. 

Some voluminous pricking bodies produce deep wounds, with bruised 
borders, which suppurate abundantly after a few days. These lesions 
must be treated like contused wounds. 

In exceptional cases, punctures may injure an artery and give rise to 
abundant hemorrhage. This requires plugging and sometimes the en- 
larging of the wound for the application of a ligature on the blood- 
vessel. 

III. 

CONTUSED WOUNDS. 

These, very unlike in their external aspect, extent, and depth, include- 
numerous varieties, representing all the possible intermediate stages be- 
tween simple excoriation and the most serious traumatisms with attri- 
tion of the different tissues of a region and the bone which forms its 
base. Most of them are extensive, badly defined, with thick ischsemic 
surrounding, infiltrated with blood and threatened with slough. 

From the therapeutic point of view, we will arrange them in three 
classes : i. Superficial, having excoriation for type ; 2. Deep, with ischae- 
miated zone of slight thickness ; 3. Deep, with wide contused zone, 
bruised and doomed to have gangrene. 

Superficial contused wounds heal quickly, almost always without 
accidents of any kind. It is sufficient to cut the hair surrounding them, 
disinfect them, and cover them with a coat of collodion or of powder of 
pulverized coal, or tannin alone or mixed with iodoform (3 to 5 parts 
to J.) Sometimes, though superficial, they are painful ; the animals 
try all the time to rub it or bite it; opiated ointment or cocaine vase- 
line may be of advantage in such cases. In some regions, especially 
the legs, a strict disinfection and an antiseptic dressing will, very often^ 
bring on recovery without noticeable suppuration. 

In deep contused wounds, whose inflamed zone is comparatively 
limited, quick cicatrization, without slough, is possible. They must be 
carefully washed, cleaned of all foreign bodies which may be deposited 
upon them, and purified with a disinfecting solution (corrosive subli- 



CONTUSED WOUNDS. 1 35 

mate, carbolic acid, creolin, chloride of zinc, or permanganate of 
potassium ; their edges must be trimmed smooth, by cutting off all parts 
too much bruised and even a little more, and they must be joined in 
places by sutures closed or far apart, with or without drainage, as the 
case may be. Little attention needs to be paid to the hemorrhage, 
even when arterioles or veinlets are lacerated ; the crushing of the ex- 
ternal coat and the retraction of the two others insure hemostasis. 
When vessels of larger caliber are opened or divided, one must guard 
against the possibility of a secondary hemorrhage and apply to then\ 
<;atgut ligatures. According to the region where the wound exists, 
this must afterwards be covered with an antiseptic dressing or with a 
■coat of vaseline, also antiseptic. If the wound gapes widely on account 
of the retraction of the tissues on the border, is without great loss of 
substance and does not threaten sjangrene, sutures may also be useful ; 
tliey bring the edges together, maintain them in proper position, make 
the space to be tilled smaller, and cicatrix is limited, so that recov- 
ery is more rapid. But when the loss of substance is considerable, 
none of the previous means is to be applied — no sutures, no drainage; 
other methods must be used. Wounds with gangrenous strips require 
washings, baths, powders, — all of an antiseptic nature, — or continued 
irrigation. 

Very severe contused wounds, whose edges are bruised, crushed, 
loose, or hollowed by anfractuosities, must be treated open, with or 
without dressing, according to the region where they exist. After 
proper cleaning by cutting, with bistoury or scissors, the disorganized 
tissues, which are doomed to gangrene, should be disinfected with 
antiseptic washings ; in some cases, free incisions and counter-openings 
should be made, to prevent the stagnation of the pus in the irregular 
and undermined structures. In some regions where the involved 
muscles are covered with an aponeurosis, the tumefied muscular tissue 
may protrude through the solution of continuity of the aponeurosis ; it 
is then advantageous to incise the latter. Sub-aponeurosis phlegmons 
should be punctured at once, drained and irrigated with antiseptic 
liquids. Contused wounds with bony lesions (face, withers, hip) 
require, ordinarily, a long time to cicatrize, and are often accompanied 
with necrosis or other secondary affections. (See N'ecrosis.) 

Of all traumatic lesions, these are the most dangerous, as regards 
infectious complications. Therefore, it is emphatically commanded to 
relieve them of whatever foreign substances they may contain, and to 
purify them of all contamination they may have received. Irrigation 
can never be too abundant, if the wound is irregular, anfractuous, un- 
<lermined, or if the tissues have been soiled with hairs, manure, gravel, 
earth or dust. When the wounded part allows it, when, for instance, 
the injury is below the knee or the hock, it should be soaked for twenty 



136 VETERINARY SURGICAL THERAPEUTICS. 

minutes or half an hour in a warm antiseptic solution. For serious 
traumatisms of the trunk and of the superior parts of the extremities, 
we have sometimes resorted during the first few days to nebulizations 
(atomizing) of corrosive sublimate or carbolic acid, made with the 
atomizer of Lucas-Championniere. Balneation or nebulizations are 
continued until the elimination of the sloughing tissues. In other 
cases, after the 'wound has been well disinfected, it is sufficient to 
irrigate several times a day with a solution of cresyl or common salt, 
and to cover it, after each washing, with iodoformed vaseline or to dust 
it with an antiseptic powder (iodoform, naphtaline, tannin, coaltar) in 
sufficient quantity to cover it entirely. Continued irrigation is also 
used with much success : it is generally employed for contused wounds 
of the extremities on horses. It removes the secretions, diminishes the 
sensibility and the pain, and attenuates the intensity of inflammatory 
accidents. It is stopped when the wound is cleaned and free from ail 
shreds of mortified tissues ; it has the inconvenience of retarding the 
cicatrization by rendering the granulations soft or fungous. The facts 
recorded by Trasbot have confirmed the remarkable efficacy of cold 
irrigations in the treatment of traumatisms of horses ; it is important 
that the water should not be too cold, since the continued action of cold 
would be injurious, especially if parts of some dimension were already 
under the influence of ischasmia. 

Warm antiseptic baths, given twice or only once a day, with iodoform 
dressings, constitute a treatment a little more complicated than cool 
irrigations, but also more certain and more rapid. We obtain good 
results with it. Recently, we have employed it with great success, for 
a saddle horse severely injured by a tramway : the canon, fetlock 
coronet and head on their anterior faces had a long contused wound, with 
ragged edges ; the tendon of the anterior extensor of the phalanges 
and the periosteum were bruised in several places ; the synovial bursa 
of the fetlock was open. No complication took place ; after a month 
the wound was entirely healed. 

It is the exception that treatment of wounds, accompanied with 
fracture of a bone of the extremities, or with articular lesions,, is under- 
taken. For them the treatment of compound fractures or of open joints 
is necessary. 

To contused wounds of the lower regions of the extremities, produced 
by the shoe, is often added a local, active, and diffused phlegmasia, 
lymphangitis, and sometimes inflammation of the tendinous or articular 
synovial sacs of the fetlock. For them especially, antiseptic baths and 
wadded dressings must be used. In some cases (horses that inter- 
fere) repetitions of the trouble must be prevented by proper shoeing or 
protective apparatus. 



WOUNDS 1-ROM 1-IRE-AKMS. I37 

IV. 
WOUNDS FROM FIRE-ARMS. (GUN-SHO^^ WOUNDS). 

Particularly frequent among army horses and hunting dogs, these 
•wounds vary indefinitely with the size and the penetrating force of tlie 
agents which produce them. How different, as far as lesions and 
severity, the contusion produced by a dead ball, the burn resulting from 
the dertagration of the powder, the narrow perforations of small shot, 
from the enormous mutilations made by big projectiles ! And how 
numerous are the intermediate degrees between those extremes. The 
wounding agent may be a regular projectile or a fragment of a small 
bomb, a metallic substance with a sharp edge or a splinter of wood 
torn by the projectile. If the latter penetrates the tissues, it may in-^ 
troduce into them a foreign body — a fragment of metal, a piece of 
leather or of cloth. 

Penetrating wounds involve injured bones in about a fifth of the 
cases. Out of 211 wounds by fire-arms observed by Jewsejenko during 
the Russo-Turkish war, 41 (igfO were complicated with bony lesions 
(bones of the head, 12 cases ; vertebrae, ribs, pelvis, 14 ; anterior legs, 
7 ; hind legs, 5 ; foot, 3). The most serious lesions were those made 
by lead projectiles. 

Wounds by fire-arms are generally characterized by their peculiar 
aspect ; their borders, of leaden tint, brown, purple, or blackish, are 
contused and ragged. Wounds made with modern arms differ much 
from those made with ancient projectiles. The Lebel ball, conical, 
with a very hard metallic envelope, has a considerable penetrating force ; 
it runs through the tissues in a straight line and perforates and crushes 
bones into splinters. The curious deviations observed from the spher- 
ical balls of old guns, the " turning " shots, are exceptional with the 
projectiles of modern warfare. 

The therapeutics of these wounds has varied with the times. Old 
surgery believed them '* poisoned " and recommended cauterization 
with the red iron or boiling oil. Later, free incisions and immediate 
extraction of the projectiles was the rule. To-day, they are treated as 
contused wounds are treated, and when the wounding agent has remained 
in the tissues, most commonly it is left there. 

In animals, since the skin is protected by an abundant coat of hair, 
it is rarely affected by burns from gunpowder ; and the incrustation in 
the skin of some of it which had not burnt is without importance. 
The eye may, however, be severely affected (Rey, Kopp). ITpon a 
horse which, at Montebello, had remained some time near the mouth 
of a piece of artillery which was firing, Kopp observed, the next day. 



138 VETERINARY SURGICAL THERAPEUTICS. 

a severe inflammation of the eye ; the entire exposed surface of the 
ocular globe was filled with little wounds looking as if they had been 
made with a punch. Subcutaneous lesions produced by dead projec- 
tiles, which push into the skin without running through — lesions attrib- 
uted in days gone to the " wind of the ball or the bullet," — must be treated 
as contusions. If the skin and the superficial subcutaneous layers be- 
come necrosed, the sloughing of the mortified tissues should be at- 
tended to. (See Gangrene.) The examination of a contused wound of 
the hoof by a ball (Kopp) disclosed the fact that the deep layers of the 
hoof were infiltrated with blood, as in a corn, and that under the wall 
there was a small hemorrhagic center. 

A load of shot, if fired at short range, has the effect of a bullet, and 
gives rise to all the disorders of the most contused wounds ; if the 
shooting is made at long range, the shot penetrates the tissues sepa- 
rately, and makes in them narrow and more or less deep tracts, at the 
bottom of which it. is enclosed in a cyst. Only the shot that is super- 
ficially situated, which is troublesome, or is arrested in delicate tissues, 
such as the eyelids or the cornea, is removed at once (Peuch). 

Wounds in the shape of gutters, hollowed in the skin and superficial 
subcutaneous layers by a ball which has reached them at right angles, 
cicatrize by granulations and without severe inflammatory reaction. 
It is sufficient to make simple washings and to cover them with an an- 
tiseptic preparation. Immediate reunion might be obtained in some 
cases if the contused condition of the borders did not prohibit. 

Tubular subcutaneous wounds, like a seton tract, produced by balls 
of all sizes, which pass through and through a region, generally close 
quite rapidly and without suppuration, except at their openings. They 
must not be probed or enlarged unless they conceal some foreign 
body ; in other cases, they are aseptic, just as the tract of a trocar 
heated to white heat, and the probing exposes them to infection or 
destroys adhesions already made and interferes with cicatrization. 
Clip the hair around the openings, wash these with a strong solution 
of carbolic acid or corrosive sublimate mixtures, cover them with iodo- 
form or iodoformed vaseline, and immobilize the region. These are 
the only truly useful measures to take. If a fluctuating center appears 
in the subcutaneous tract, it should be punctured, the cavity washed, 
all foreign bodies that it may contain removed, and then it should be 
dressed as the openings were. When the tracts of the wounds running 
in the depth of a region pass through an aponeurosis, if the tissues 
underneath become highly inflamed and suppurate, it is necessary ta 
enlarge the tract and drain it. The hemorrhage which takes place in 
some cases is also a condition which demands free incisions, but the 
march and the gravity of the trouble depend, after all, upon the impor- 
tance of the injured organs. It is evident that balls, which thus 



WOUNDS FROM FIRE-ARMS. 1 39 

run through some regions, may produce mortal accidents (perforation 
of the intestines, of the lung, of the heart, or of the brain.) Let us 
again say that a projectile that breaks up upon a bone may make three 
openings on the skin; and that the existence of two openings is no 
proof that the region has been run through, as the two openings may be 
those of entrance of two balls which have not made their exit. 

The projectile has penetrated the tissues in making a blind tract with 
one opening only : it remains in the region : what is the treatment ? 
Of yore, extraction, whenever possible, was recommended ; but numer- 
ous facts have shown that the balls, which are almost always aseptic, 
are tolerated in the great majority of cases. Then systematic absten- 
tion is the rule of conduct adopted now by most surgeons. The wound 
and its surroundings is carefully examined : sometimes palpation re- 
veals a hard spot, a slight projection formed by the ball ; with a stroke 
of the bistoury those are brought out that are arrested just under the 
skin ; those that are lost in the depth of the tissues or have penetrated 
the viscera are left alone. Wounds of the lung are relatively harmless 
compared with those of the encephalon, spinal cord, or heart, which 
are nearly always fatal. The penetration of a ball into abdominal or 
thoracic cavities is not necessarily followed by complications ; and the 
rule is, not to attempt the extraction. The question in human surgery 
as to the course to take with abdominal wounds is yet undecided. 

Reclus, who is a great admirer of abstention, admits interference 
" not for the extraction of the projectile, but to repair the mischief it 
has done by its passage : such as, the opening of an artery or a large 
vein ; the section of a nerve or of a tendon ; laceration of a viscus, 
the stomach, an intestine, or the bladder. " We do not interfere for like 
occurrences among our large domestic animals. For the others, one 
must be guided by rules laid down in human surgery. We will return 
to this subject in the chapter on Traumatic Lesions of the Intes- 
tines. 

When the projectile is arrested in a musculo-aponeurotic region and 
produces in it violent inflammatory phenomena, it must be looked for 
by exploration of the tract of the wound. Sometimes the size of the 
canal permits the introduction of the index finger, but ordinarily it has 
to be enlarged by incision : an aseptic grooved director is intro- 
duced into the tract, and a straight bistoury passed along the groove 
carries the incision on to the necessary extent. When the projectile is 
exposed, it is made loose with the extremity of the probe and extracted 
with the denticulated jaws of long forceps. One should avoid violent 
manipulations, which might result in injuring the tissues more or in 
pushing the ball farther inwards : this recommendation is specially im- 
portant for projectiles arrested in the neighborhood of serous mem- 
branes. Bony lesions are always serious complications, with, however, 



140 VETERINARY SURGICAL THERAPEUTICS. 

many variations in their gravity. Ordinarily, balls which are incrusted. 
in bones are left in ; if they are extracted, they must be made loose by 
careful manipulations with the probe or a strong metallic rod ; some- 
times the operation is quite difficult, and may demand the use of the 
trephine, the yauge, and the mallet. The special instruments invented 
in former times to extract projectiles are not employed now. 

Fractures of the bones of the face, which are not extensive, also 
those of the spinous processes of the withers, of the point of the hi.p, 
and of the ischial region are the least dangerous. On the contrary, 
those of the bones of the extremities, which are often comminuted, as 
well as the articular lesions, are cases of extreme gravity, and are, econ- 
omically, incurable. Wounds of arteries and large veins — cases which 
are rather rare — give rise to an immediate and abundant hemorrhage, 
and ordinarily require the ligature of the injured blood-vessel. 

If, in general, the tissues are tolerant of balls, they are not so of the 
foreign bodies which the balls have carried with them. For those, ex- 
traction is almost always necessary ; and this should be done with long 
forceps. 

Projectiles of large caliber (boulet. obus), almost always produce 
enormous lesions. At times, they take off a leg or a part of the head ; 
at others, they reach the neck or the trunk, thus causing, in nearly 
every instance, irreparable disorders, if not death in a few minutes. 
Even when the thoracic and abdominal walls appeared but little injured, 
the viscera — lungs, heart, liver, and intestines — are contused, bruised 
or torn. Some regions, however, maybe touched side-wise and injured 
quite deeply, without complications of fracture, injury of large vessels 
or important nerves, or opening of a natural cavity. These trauma- 
tisms present all the characteristics of serious contused wounds, and 
must be treated as such. 

Though wounds by fire-arms are ordinarily free from infection, they 
may be complicated with diffused phlegmons, gangrene, pyohaemia, 
septicaemia or tetanus. The last two infections are generally the result 
of an inoculation of the wound, after the injury by the earth, the dust, 
or other matters containing the septic or tetanic germs. 

In cases where treatment is undertaken hygienic measures should not 
be neglected. If the wounded is suffering from the shock, and is weak 
or depressed, stimulants and tonics should be administered. 

Projectiles, left in the tissues, behave in different ways. There are 
some which, having reached certain organic cavities (nasal, buccal 
pharyngeal, stomachal or intestinal) or having been arrested in these 
are eliminated through the natural passages. It is thus that balls which 
have entered the intestines are rejected through the anus. Que'nu has 
related to the Society of Surgery, a case particularly curious : a man 
who had received a ball from a revolver threw it out three weeks later 



WOUNDS BY TEARING. 14I 

by the pharynx (^). In other cavities, if they remain, they may produce- 
suppurative /inflammation. The biscaien that Rigot found in the gut- 
tural pouch of a horse, which he dissected, had given rise to a sup- 
purative collection in that sac. Many become fixed, or encysted, 
and after the wound which tliey have made has cicatrized, nothing 
remains to indicate their presence. The observation of Trasbot is an 
example of it. At the autopsy of war-horses, balls were found enveloped 
in a cellulo-fibrous case in various regions, even in the viscera. In man, 
they have been found in the brain. But there are projectiles, which, while 
remaining innocuous for years, travel along conjunctive layers, moving 
by the laws of gravity or through the effects of muscular contractions. 
In general, they move slowly, giving time for encysting to take place ; 
then, under the influence of the continued pressure that they make upon 
the dependent portion of their cystic envelope, the latter gives way, and. 
the body thus progresses slowly through the tissues ; the walls of the 
cyst close, unite, and form a fibrous tract, which may be found after- 
wards (Ferrier). In a horse, which was wounded, in 1866, with a ball 
that had entered the lumbar region and could not be extracted, MoUer 
found, ten years afterwards, the projectile near the umbilicus ; it had 
produced no trouble during all that time. Sometimes, in thus displac- 
ing themselves, or even in remaining in one place, projectiles give rise, 
on occasions, to various accidents — abscesses, neuritis, arthritis, or in- 
flammation of the large serous membranes. The horse spoken of by 
Garnet, kept for four months, in the lumbar region, a ball which, one 
day, after a long journey, gave rise to an acute diffuse phlegmasia, and 
an abundant suppuration, followed by death in a week. (See Foreig?i 
Bodies. 



V. 
WOUNDS BY TEARING. (TORN WOUNDS.) 

This kind of wound is observed in all animals ; but with the excep- 
tion of the wrenching of the hoof, most of them, generally of little gravity, 
have nothing compared with the great traumatisms, now so frequent 
among men, because of the extensive part machinery takes in modern 
industry. 

Ordinarily the torn wounds that we have to treat in animals 
are made by nails or hooks, and are very much like contused 
wounds with a thin ischaemic zone. Very often their edges are as 
nearly regular as those of incised wounds ; and when they are recent, if 
their borders are brought together after having been minutely cleaned 
of all soiling on their sutures, they may unite by first intention. This 

{}) Quenu, Semaine Medicale, 1894, p. 328. 



142 VETERINARY SURGICAL THERAPEUTICS. 

result is often obtained for wounds of the lips, of the nostrils, eyelids, 
and for those which, in all regions, involve only the skin and the super- 
ficial subcutaneous layers. 

Upon animals that work in railroad stations, mines, and iron found- 
ries, more extensive and deeper lesions can be seen, — wounds with tear- 
ing of the muscles, and the tendons, and with fractures. Rey has 
related the case of a horse, which was thrown on the rails while draw- 
ing cars, and was dragged thirty meters and found covered with 
wounds, the lower jaw having been fractured as far as the neck, hooked 
to a switch, tiie bone had been fractured and its lower part was held 
only by a thin band of tissue. Violent contusions applied obliquely, 
and bites also, give rise sometimes to lesions resembling torn wounds. 
There are several cases of horses, an ear of which has been taken ofif 
by a bite or by a kick. 

Large tearings, when curable, must be treated as contused wounds. 
They must be carefully disinfected with washes or warm antiseptic 
taths, and their edges brought close together with sutures and covered 
■with an iodoform dressing. A simpler and more economical treatment 
consists in washing them frequently and covering them with absorbent 
or antiseptic powders. 

When these injuries are situated on the legs, continued irrigation is 
ordinarily employed. (See Wrenching of the Hoof.) 



VI. 

W^OUNDS FROM BITES. 

These wounds have various characters, according to the animal that 
has made them. They may have the aspect of cuts, punctures, 
bruised, contused or torn wounds. Those made by horses are prin- 
cipally contusions or contused wounds ; the tissues are bruised and 
crushed ; two curved marks separated by an oval tumefied zone are 
sometimes made on the skin by the incisives; when the skin is torn, 
the wound is, ordinarily, irregular and ragged, even sometimes when the 
edges are clean. Wounds made by large ruminants, rare and not se- 
rious, look, also, like contusions and contused wounds. In the bites of' 
dogs, the wounding dental arches make several punctures, with crushing, 
cuts, and tearings of the tissues. With those of cats, one or several 
punctures, generally somewhat deep, are found made by the canines. 
Bites of large carnivorous animals are terrible ; often there are lacera- 
tion of tissues and disorders rapidly fatal. Some birds with their 
straight or crooked beaks may make bites by punctures or by tearing. 
Large bites made by horses are rather often complicated with crushing 
of bones; the muscular force that closes the jaws is considerable,- 



roisoNEi) wouxDS. 143 

sometimes the lower jaw breaks viiider the effort (See Fractures). Also 
there are found the bites that dogs infiict upon each other during 
fighting, fractures of the bones which form the basis of the wounded re- 
gion (face, extremities). \\'e have just treated a hunting dog bitten 
deeply on the shoulder by a bull-dog, in a short struggle, and in which 
the neck of the scapula had been fractured by a bite of the teeth. 

The therapeutical treatment that all these lesions require, allow them 
to be arranged in two groups : i. Those where the contusion is more or 
less severe ; 2. Those where the skin is perforated or torn. 

Bites of the first variety heal, ordinarily, without complications. To 
allay the pain, often great, tepid affusions or baths are used ; some- 
times emollients and narcotics. If the bruised structures undergo 
mortification, their sloughing can be stimulated and the wound treated 
as ordinary contused wounds are. 

Bites of the second variety — bites open or with wounds — must be 
carefully disinfected with free antiseptic irrigation or immersion in a 
tepid bath. The lesions, sometimes deep, that are inflicted with the 
teeth do not exhibit all the gravity of the injury; there is also the pos- 
sible infection with the saliva or other noxious substances which the 
teeth may have carried into the wound. Not only does saliva contain 
toxic leucomaines, but also numerous microbian species which can 
bring on an intense local phlegmasia, suppuration, and phlegmons of 
the wounded region. Tetanus, erysipelas, pyohaemia, are complications 
to be feared with serious bites. Minute disinfection of the wound and 
antiseptic dressings are the best preventive treatment of all such acci- 
dents. In some cases continued irrigation will be preferred. As in 
contused wounds, it may be necessary to make some excisions or to 
enlarge wounds with incisions or counter-openings. 

Generally wounds from bites bleed little. They may, however, be ac- 
companied with abundant venous or arterial hemorrhage, which then 
necessitates the enlarging of the wound and the application of ligatures. 
Latulle treated a horse which, having been bitten (probably by his 
mate) on the right side of the neck, near the jugular, had on that point 
a ragged wound from which red blood escaped. The jugular and the 
carotid had been opened so that ligature was required, (i) 

VII. 

POISONED WOUNDS— VIRULENT WOUNDS. 

Whatever may be the causes and the mode of their production, 
whether due to the action of a wounding body or a bite, these wounds 
are essentially characterized by the deposit, in the injured tissues, of a 
deleterious substance — poison, venom or virus. What makes thenx 

(i) Latulle, Journ. of Milit. Vet. Med. 1S67-6S, p. 413. 



144 VETERINARY SURGICAL THERAPEUTICS. 

serious, is the introduction of this injurious substance into the traumatic 
center ; if, however, the extent and the depth of the lesions are suffi- 
cient to influence the accidents that may follow, by opening a more or 
less wide entrance to absorption, they have only a secondary impor- 
tance. 

For a long time it was believed that there was a rapid and complete 
absorption of the soluble poisons, venoms and virus ; but experiments 
have shown that if most of these agents diffuse easily, the absorption 
of them is influenced by numerous circumstances, and, during a certain 
time, a part remains on the wound, as well as in the superficial layers of 
the wounded tissues. Among these agents, there are those which spread 
quietly in the tissues, and are absorbed without producing any local 
reaction ; others, possessed of very active phlogogenous properties, 
■which gave rise all round the traumas to intense inflammatory mani- 
festations ; and also others, caustic in character, which produce the 
scarification of a peritraumatic zone more or less extensive. 

Poisoned Wounds Proper — and under this name we include those in 
which are deposited vegetable poisons (alkaloids), mineral (mercurial, 
-arsenical, carbolic acid, iodoform) or putrid poisons (ptomaines) — carry 
with them a requirement of the first importance : immediately and pro- 
fusely irrigate the wound with water or an antiseptic solution, thus freeing 
it from the toxic matter which has not yet penetrated the surrounding 
structures ; remove either by ablation or cauterization (according to the 
nature of the case and the toxicity of the substance), the superficial layer 
of the trauma or keep soaking the affected part in a tepid antiseptic 
bath ; and administer internally an emetic, stimulants or tonics, or 
agents with special therapeutic properties (antidotes). 

The venomous wounds that we have to treat in France are made by 
adders, the viperc aspic and the vipcre pcliade (Kauffmann). The former 
is the more dangerous ; its venom often proves fatal to small animals 
(dogs, sheep, goats) ; it may kill large animals also, as is recorded in 
many instances. The second makes wounds more superficial and less 
'dangerous : it frequently, however, causes the death of small animals 
when they have not been properly treated. Out of sixty ewes of a 
flock, bitten by adders, fourteen died (Roche). Channel (from Bourg) 
has recorded that a br6od mare which was bitten on the udder, died 
five days afterwards. Krebschmar also treated, without success, a dog 
bitten on the lip. Cases of this kind are not rare. 

The therapeutics consists: i. In arresting the circulation in the 
wounded region, to prevent or to stop the penetration of the venom into 
the system. 2. In removing that which may remain in the wound. 
3. In contending against local and general accidents. 

First, if the region permit it, a ligature should be applied, and tied 
somewhat strongly above the wound, to arrest the circulation. An 



POISONED WOUNDS. I45 

elastic cord is preferable to all others ; if one is not at hand, a tourniquet 
may be improvised with a piece of cord or a twisted handkerchief 
which is tied and twisted with a piece of stick, a key or the handle of a 
pocket knife. This ligature in place, attention should be directed 
towards the wound. It should be carefully washed with cold water ; 
often it may be enlarged advantageously ; its edges should be compressed 
to expel the venom which may be infiltrated in the tissues and which 
may be removed with another washing ; if the fang of the adder has 
remained in the wound, it must be extracted. Hemorrhage is beneficial ; 
the blood washes the wound and removes a certain quantity of the 
venom. Suction of the wound might be made without bad results ; the 
venom has no toxic action on mucous membranes. This, however, is 
seldom used for animals. The local treatment is completed by 
cauterization with a strong caustic (chromic, sulphuric, or nitric acid, 
chloride of zinc) or with the red hot iron. Light caustics (ammonia, 
nitrate of silver) are useless. 

If the borders of the wound are already inflamed, the same method 
should be pursued ; but it is good, besides, to make scarifications on 
the tumefied zone and to introduce into them antiseptic mixtures. 
The injections of carbolic acid, 3 p. c. (\\'aadt), 5 p. c. (Billroth), of 
solutions of permanganate of potassium i p. c, or of chromic acid 
(Kaufmann) may prevent local troubles or diminish them should they 
already exist. The numerous specifics recommended here and in 
foreign countries have not given what they promised ; it is better to 
hold on to those which possess known properties. For general treatment, 
one should have recourse to diffuse stimulants (wine, alcohol, ether, 
acetate of ammonia). In South America, drinking of alcohol to 
drunkenness is considered, for men, an excellent means to prevent 
death. Hypodermic injections of strychnine (Muller) have also given 
satisfactory results; the ligature or tourniquet should not remain 
more than six or eight hours, if one would avoid gangrenous complica- 
tions. 

Venomous wounds of some arachnida (scorpions, tarantula) are 
treated in the same way. 

For bites of adders or snakes, as for injections, prophylaxis has been 
studied. At first it was observed that the organism seems to accustom 
itself to the action of the toxic : repeated injections of small doses 
seemed to allow it to resist better large doses ; nevertheless, these still 
had sufificient power to kill. (Kaufmann, Calmette, Phisalix and 
Bertrand) ; later, from this it was found possible to confer on animals 
immunity from the venom of snakes. The serum of animals thus 
rendered proof against poison is antitoxic. 

Stings made by bees^ ivasps, or hornels are accompanied with great 
pains and a large diffuse swelling, at times quite extensive ; but in 
10 



146 VETERINARY SURGICAL THERAPEUTICS. 

general these phenomena do not last long, and are not complicated with 
serious accidents, except among small animals, where cases of death 
are frequent, Lange tells us that out of seven geese attacked by a 
swarm, six died within from seven to ten minutes ; the seventh remained 
blind. H. D'Arboval has seen two dogs die from the stings of bees. 
Other cases are recorded by Crepin and others. Sanitas treated a horse, 
which after being stung by hornets, was taken with severe abdominal 
pains. and with epistaxis. The horse whose case is published bySaint- 
Cyr had been stung by bees on the head ; the entire lower part of the 
face became the seat of a large tumefaction, warm, painful, especially 
well marked on the lips, the nostrils, and the eyelids. The difificulty 
of respiration due to the swelling of the nose had to be relieved by 
tracheotomy. 

When the stings are numerous, even large animals may succumb 
rapidly. Guerin de Champneuf reports that a mare and her foal, 
attacked by a swarm of bees, died after great sufferings. Herron has 
treated a donkey which died under similar circumstances. Horses 
have died in ten hours (Albrecht, Funfstiick), in six (Funsftiick), in five 
(Clichy, Albrecht), in two (Clichy), in one (Guilleville.)* In xh^ Rccaeil 
of 1853, Clichy reported the case of five horses, which, having been 
attached to a wall, were attacked by an immense number of bees and 
died, — two in two hours, the other three within from four to five hours, — ■ 
after having, every one, presented symptoms indicating violent pains 
and a super excitation. Guilleville reports that five horses, closed in a 
wagon, were killed in one hour by bees. In grave cases, the venomous 
substance produces a severe inflammation of the skin and of most of 
the mucous membranes, or patches of cutaneous gangrene, hyperaamia, 
hemorrhages, oedema of the viscera, especially of the lungs, of the 
brain, or of the meninges. 

If one were called to help in a case where bees or hornets had attacked 
animals and were still attached in large numbers, he must at first attend, 
to removing the bees, carefully protecting himself, of course, with gloves, 
cap, mask, etc. Since these insects " fear water," the best way to 
make them go, is to throw some on their victims. Afterwards, the 
treatment calls for simple cold water affusions, or lotions with alkaline, 
ammoniacal, narcotic solutions or petroleum. Lang recommends the 
following mixture: liq. ammoniae 15 parts; collodion, 5 ; salicylic acid 
one. 

We shall not advise friction for the purpose of tearing out the stings 

*C. Peabody relates the case of a horse, 12 years ago, which died in a little over 
six hours. He records also an experiment made with an animal which he had stung- 
with a swarm of bees and which he treated successfully by officinal solutions of 
potassae internally and hypodermic injections of morphia. (Amer. Vet. Rev. vol. 22, 
p. 613). (T). 



POISONED WOUNDS. I47 

fixed in the skin (Clichy) ; such friction is painful, and does not loosen 
liiese slings, since they are protected by the hair ; they can be pulled 
away with nippers from the surface where they may be seen. Often 
small abscesses form in the places where these were. Where the stings 
are numerous the inflammation extensive and manifestations general, 
stimulants (alcohol, ether, camphor, coffee) are the most efficacious 
agents. If the swelling of the nose, pituitary or laryngeal mucous 
membrane renders the respiration difficult and loud, and asphyxia is 
threatened, tracheotomy should be performed. 

To protect animals against certain winged insects (breeze fly, horse- 
fly), which are very troublesome during warm weather, giving pain and 
producing swellings on the skin, blankets, or nets, may be used. 
Ordinarily, the skin is simply washed with solutions of strong odor 
(tobacco, decoctions of walnut leaves, vinegar, cresyl, carbolic acid and 
2-3 ^c tar, asafoetida). Inflammatory symptoms are treated by shower- 
ing with water or washing with alkaline solutions. 

Virulent luoiuids, due to the introduction into injured tissues of a 
ferment that grows and multiplies indefinitely, present a gravity which 
varies with the malignity of the ferment. Local phenomena and gen- 
eral accidents depend exclusively on its properties : quantity is of little 
importance, since on account of the faculty of the virus for pullulation, 
the weakest doses are ordinarily sufficient to bring about infection. 
Bacteriological researches of the last fifteen years have extended the 
domain of virulent wounds : to glanders, rabies and anthrax, they have 
added tuberculosis, tetanus and septicaemia, not to mention others of 
■less importance. All these infections have a period of incubation,, 
which is of variable duration. Sometimes the lips of the wounds are 
vapidly overrun by an intense phlegmasia produced by the local action 
of the virus (anthrax, septicaemia); sometimes this phlegmasia appears 
only after a few days (glanders), in other cases the wound acts as an 
ordinary simple one, granulates and cicatrizes, and weeks or months 
may pass before the first troubles, due to the infection, are manifested 
(rabies). 

Experimentation has proved that most virus is rapidly absorbed. 
Some local conditions may retard the absorption, but generally tlie 
blood that circulates through the wounded region has in a few minutes 
retained and carried in its course a sufficient quantity of specific ele- 
ments to produce infection. (Renault, Davanie, Rodet). Therefore, 
a quick and rapid interference is imperative, if one wishes to prevent 
surely the dreadful consequences of virulent inoculations. 

As for venomous wounds, one must, when possible, arrest the circu- 
lation with a ligature placed above the wound. This should be washed 
freely with water, its borders squeezed, the extravasated blood and 
the virulent matter which may have penetrated the tissues expelled. 



]4^ VETERINARY SURGICAL THERAPEUTICS. 

Hemorrhage thus stimulated by the water flow is advantageous ; the 
blood oozing out cleans the wound and carries with it the noxious ele- 
ments. It is evident that the chances of success depend very much 
upon the length of time that has elapsed since the insertion of the 
virus, ^^'hea this has had time to spread in the tissues, washing, 
squeezing and hemorrhage are no longer to be trusted. The only safe 
way — and it is sufficient, if the infectious elements are still in the parts 
surrounding the wound, if the circulating blood has not already scat- 
tered them in the organism, or if the lymphatic circulation has not car- 
ried them further — is the free destruction of the peritraumatic zone 
by caustics and the red-hot iron. It makes no difference what agent is 
iised, providing it be powerful and applied immediately. Heated to a 
white heat, the cautery " roasts " the Vv'ound, penetrates its borders, 
reaches the anfructuosities, and goes on even to the healthy structures. 
Liquid caustics — nitric, muriatic and sulphuric acid, chloride of zinc 
and chloride of antimony — destroy also the entire infected layer and 
the suspected zone. It is sometimes necessary to make several deep 
eschars, and one should not hesitate, since success depends upon it. 
Let us add that a late energetic interference is not always barren of re- 
sults. Many times the red-hot iron, applied several hours after the 
deposit of the virus, has prevented anthrax infection (Davanie, Rodet). 
In the same way cauterization of a rabid wound, one hour after the 
bite, has been beneficial. Ammonia, nitrate of silver and several other 
light caustics, recommended in olden times, are absolutely useless. As 
for the so-called specific antidotes, secret remedies and mystic prac- 
tices, only ignoramuses have faith in them. 



VIII. 

GRANULAR WOUNDS. 

Gfaniilar ivoiinds, also known as granular dcrmitis, smnmer ivoutids, 
are frequent in warm climates, quite common in the meridional coun- 
tries of Europe and the south of France, but rare in our latitude and 
altogether exceptional in Northern regions. Sometimes they appear 
suddenly and seem to bethe result of the action of nematodes (^\vo\\.2^ 
which reach the dermis, by ways still unknown, and, settling there, pro- 
duce a vegetating dermatitis with peculiar characteristics; at others 
they constitute a secondary affection, complicating exposed traumatic 
lesions (wounds, sero-sanguineous collections, cysts, open abscesses). 
Their principal attributes are, a protruding granulation, which covers 
the entire diseased surface ; also caseous or cretaceous granulations, 
round, angular or irregular and of a yellowish-gray color ; and a great 
itching, which induces constant rubbing. 



SUBCUTANEOUS WOUNDS. I49 

They are very obstinate wounds to cure, generally resist all the 
numerous remedies recommended : emollients, narcotics, astringents, 
vesications, light caustics, cold affusions or continued irrigation. They 
can only be healed by excision of the granulations and fungosities with 
the bistoury, or by destroying them with energetic caustics, such as the 
red-hot iron. 

If the wound is superficial and spreading, the granulating surface 
should be excised. Often, however, they are implanted so deeply that 
the curette must be used in addition to the bistoury to remove them 
completely. With the curette it is easy to clean the walls of the cavi- 
ties where the layer of morbid tissue presents sometimes considerable 
thickness. When the wound is once cleaned, it is covered with a dress- 
ing, or treated with frequent applications of antiseptic vaseline. 

When actual cauterization is used, all the morbid tissue must be de- 
stroyed with cauteries in point, heated to sherry red or white heat and 
pushed into the deepest layer of the diseased part. If the punctures 
thus made with the cautery are very close, the entire granulating sur- 
face is transformed into one eschar, which suppuration soon eliminates. 
After cauterization, it is advantageous to have recourse to continued 
irrigation. 

There are granular wounds which, during the warm season, resist the 
abrasions of the granulating layer, and cauterization. They go back to 
their former condition and last until the end of fall or even until late in 
winter. 

In meridional countries, some of these wounds are seen to assume an 
'ulcerous character, gradually spreading in width and depth, without 
being any better during the cold season. When they have resisted 
several successive operations, it is better to destroy the patient, if it is 
'of little value, than to continue a treatment doubtful as to its results. 



IX. 

SUBCUTANEOUS WOUNDS. 

Whether from accident or from an operation, subcutaneous wounds 
■of like dimensions are much less serious than exposed wounds. The 
traumatic center has a temporary continuity with the outside through 
a small solution of continuity, but this soon becomes obliterated ; the 
tissues are then protected against infectious agents, and if the wound- 
ing body has not infected them, cicatrization takes place rapidly, as 
with protected wounds. The inflammatory phenomena are slight, 
diminish after a few days and soon disappear; and since the skin is 
divided only for a short distance, the pain is moderate. Struck with 
the benignity of accidental subcutaneous wounds and the rapidity of 



150 VETERINARY SURGICAL THERAPEUTICS. 

their cicatrization, J. Guerin, about the year 1S40, invented the sid>-- 
cntancoHS method, the value of which has been considerably diminished 
by antisepsis. We use it, however, for some operations, especially in 
plantar tenotomy, in cervical or patellar desmotomy and in caudal 
myotomy. 

Subcutaneous wounds, which are free from infection, and have a. 
natural tendency to heal, require simple treatment. This consists 
principally in closing the solution of continuity of the skin with a 
collodion cover, after a thorough cleansing of the region. A light com- 
pressive antiseptic dressing is sometimes useful. The wounded region 
sliould be immobilized as much as possible, to avoid the rubbing of 
tlie surfaces which are to unite the loosening of the exudation collected 
between them, or the irritation of the newly-formed tissue. Sul)- 
cutaneous wounds of operations made in healthy tissues are always 
aseptic, and cicatrize by adhesive union when sufficient care has been 
taken. Accidental subcutaneous wounds do not always act in sucli a 
simple way ; they often suppurate and may be complicated with other 
accidents ; they belong then to the series of exposed wounds. 

X. 
CONTUSIONS (BRUISES). 

Contrary to what is. customary, we have separated avitusions froni 
contused 7uounds. If both are made by a similar mechanism by the 
action, upon tissues, of blunt, bruising bodies, and although since the 
beginning of the era of antisepsis, the principal clinical characteristics, 
which distinguish them — absence or presence of a solution of continuity 
of the skin — is less important than in past days, among animals, they 
still offer sufficiently great differences to justify this division, — also 
taking into consideration their gravity, progress, mode of repair, 
possible complications and the therapeutics that they require. 

Constituted essentially by a traumatic lesion — laceration, bruise or 
crushing of the subcutaneous tissues — without solutions of continuity 
of the teguments, contusions are of very varied form and gravity. 
Sometimes the disorders and the functional symptoms are exclusively 
local ; at others, there ai-e distant troubles. It is for this reason that 
contusions which are united on the lateral side of the head may give rise 
to facial hemiplegia. Nervous branches (radial, sciatic, external 
popliteal) ma}' be injured on the extremities, and paralysis will be 
observed to follow, which lasts for a longer or shorter time. 

Considered as lesions, they are divided into three classes : coiifiisioiis 
of the first degree, with rupture of the capillaries of the skin or of the 
subcutaneous tissue and W\\\\&Qc\\-)-v(\o'i\'s,\ contusiotis of the second degree,. 
M'ith rupture of small blood-vessels, and formation of a bloody en- 



CONTUSIONS. 151 

largement ; contusions of the third degree, with destruction of the tissues 
and more or less extensive mortification. The priitiitive effusions of 
scrosity and of liquid greasy matters will be considered in the next 
chapter. 

The contusions of the first degree, with or without excoriation of the 
epidermis, heal by natural processes. Rest, only, is required for the 
diseased part. One may, however, use with advantage, especially if 
there is swelling, either antiphlogistics — cold epithems, compresses wet 
witii cold water or an astringent solution (alum water, white lotion, 
solution of metallic sulphates) — or slight resolutive topical remedies 
If pain is severe, narcotics will allay it (poultices or opiate ointments), 
or analgesics (cocained vaseline), and also fomentations or continued 
immersion in warm water. Scarifications, recommended by some 
French and other authors, must not be used. 

For contusions of the second degree, more active interference is de- 
manded. If they are recent, cold water, or salt water, applications 
and simple white lotions (that of alum) are useful ; they hasten 
hemostasis and arrest the growth of the bloody tumor. Later, one 
should use resolutive lotions (various tinctures, camphorated alcohol), 
and the tincture of iodine painted over the parts ; beside these, massage 
Avhich spreads the extravasated liquid over a wider surface and stimu- 
lates its absorption ; or also methodic pressure, made with an India 
rubber band, or one of linen or of flannel, if the bloody swelling is 
upon an extremity. 

These means fail when the tumor is old and surrounded by fibrinous 
strata and an organized membrane, — in a word, when it is encysted. It is 
for such cases that sudden and rather strong compression has been 
recommended to rupture the wall of the pseudo-cyst, or puncture or 
incision of this wall, and irritant injections into the pouch after evacu- 
ation of its contents. For bloody tumors with clots, one should 
puncture with the larger trocar of Dieulafoy or that of Potain. The 
liquid should be expelled by methodical pressures made upon the 
swelling, followed by a washing of the pouch witli a strong solution of 
carbolic acid, cresyl, or tincture of iodine ; a compressive bandage 
should be applied, if the region permits it. When the walls of the 
bloody collection are thickened, already doubled up by a neo membrane, 
the effusion returns ; a new puncture and another antiseptic injection is 
required. Some hematomas contain large clots, whose exit from the 
cavity through a simple puncture is impossible. They must be opened 
with an incision sufficiently extended to permit the removal of these 
clots; afterwards, they are to be treated as other bloody collections. It 
is rarely necessary to have recourse to curetting of the walls. If 
suppuration occurs, the pouch must be freely opened, irrigated, and 
drained. 



152 VETERINARY SURGICAL THERAPEUTICS. 

Independently of all surgical interference, contusions of the first and 
second degrees may exceptionally present, at certain times, well 
marked inflammatory phenomena and terminate in suppuration. The 
specific agents of the latter have reached the traumatic center, either 
through superficial excoriations that have denuded the papillar layer 
of the tegument, or by vascular channels, when the blood is accident- 
ally infected. 

In contusions of the third degree, the lesions are often very serious. 
The muscular layers are crushed, the interstices of connective structure 
are extensively gorged with blood ; the skin soon becomes mortified, 
the contusion is transformed into an open wound and exposed to all 
the dangers of contused wounds. Recent contusions are, in general, 
treated with antiphlogistics, especially with continued irrigation ; but 
warm afi^usions or fomentations — warm baths for small animals, or, if 
possible, for large — are to be preferred. When enormous extravasa- 
tions exist in contused regions, puncture and antiseptic washes form a 
good treatment. If suppuration occurs, free opening and cleaning of 
the irregularities of the cavity with strong disinfecting solution (chloride 
of zinc 5-8) and drainage to assist the flow of the discharge, are the 
requirements. In contusions produced by large bodies which have 
moved with great force, often large vessels are thrombosed, nerves 
crushed, and bones fractured. One must know how to appreciate the 
gravity of such disorders in order to decide as to the fate of the 
patient. 

XI. 

PRIMITIVE TRAUMATIC EFFUSIONS OF LIQUID FATTY 

MATTERS. 

These, which are frequent in heavy draught horses, less so in cattle, 
and which are exceptional in small animals, occupy ordinarily the regions 
exposed to external violence and friction, and where the skin lies, witix 
the intervention of a conjunctive layer, upon a resisting aponeurosis. 
They are most often found on the haunch, thigh, stifle, over the mass of 
the muscles of the elbow, sometimes the withers, external face of the 
shank, and the hock. Their mode of formation is the same in animals 
as in man : they are the consequence of pressure made obliquely upon 
the skin, and sufficiently great to lacerate the subcutaneous connective 
layer; the adherences established between the skin and the aponeurosis 
are more or less completely destroyed ; a cavity, often large, is formed, 
in which serosity accumulates or an oily liquid when the torn connective 
tissue is much infiltrated with fat. Pressure of the breeching strap, 
below the haunches, or on the external face of the thighs, kicks, and 
falls from slipping, are the principal occasional causes of the efifusion& 
observed in horses. 



EFFUSIONS OF LIQUID FATTY MATTERS. 1 53 

The subcutaneous detachment becomes filled with liquid, sometimes 
slowly, then again rapidly, but, in general, without noticeable inflam- 
matory phenomena ; a soft swelling, uniformly fluctuating, is formed. 
It seems that, in the collection of serosity, the exudation comes both 
from the lymphatics (lymphorragy) and from the stretched blood-vessels, 
allowing only the passage of the serous portion of the blood. In fatty 
collections^ the pocket is filled with fatty drops, issuing from the sub- 
dermic connective tissue. 

The seat of the swelling, the absence of phlegmasic phenomena or 
their slight intensity, the total and uniform fluctuation, clearly indicate 
the nature of the disease. The diagnosis presents no difflculties. 

The effusion of serosity has no tendency to disappear spontaneouslv ; 
when it occurs one must have recourse to active therapeutics. Among 
the means recommended are : puncture, and injection of iodine 
(Leblanc, Nocard), incision of the walls of the cavity (Leblanc, Adam, 
Violet), drainage of the pocket by a seton passed through it vertically 
or with several runs towards the most dependent point of the swelling 
(Neumann), and, finally, blistering applications. 

Puncture with the trocar is always insufficient; it allows, ordinarily, 
the entire evacuation of the liquid ; but in a few days, often the next, 
the swelling has returned. On the extremities we have also tried many 
limes, without success, puncture, and compression with a wadded dress- 
ing. Irritant injections (pure or a diluted tincture of iodine, strong 
antiseptic solutions) made in the pocket after the evacuation of the 
liquid, not uncommonly are followed by recovery ; the two opposite 
walls of the cavity become inflamed and rapidly adhere to each other ; 
in the great majority of cases, however, several injections, a week 
apart, have to be made. When the operation is not done aseptically, 
the cavity suppurates and, like abscesses, must be treated by incision 
and detersive injections. 

With vesicating frictions, the absorption of the effusive fluid is 
rarely obtained ; it demands a long time, and often one is obliged to 
end the treatment by having recourse to other means. 

Cauterization with spaced deep points is principally useful for old 
serous collections on the extremities. 

Puncture, or iodine injections associated with blisters, give relief, 
either by giving rise, in the pouch, to modifications, which, as after the 
simple iodine injection, dry up the exudation ; or again by starting ia 
it a suppurative inflammation. 

It is by producing suppuration that setons, inserted through the 
cavity, act. A fenestrated drain, secured at both ends, exposes the 
skin less than setons to tearings and lacerations, it better insures the 
flow of the pus, and gives the same results. 

Extensive incision, made at the start, has the inconvenience ai expos- 



154 VETERINARY SURGICAL THERAPEUTICS. 

ing widely tissues destitute of all protection, in which septic elements 
can find a good soil. Even in former times, infectious complications 
were much feared : before incising, the condition of the walls of the 
cavity were modified. To-day, we know how to avoid those complica- 
tions ; and the incision of the pouch made at the dependent part, the 
fixing in the wound of a short drain which permits the escape of the 
serosity as it is secreted, and the strong antiseptic injections (chloride 
of zinc, carbolic acid or creolin 5 <^, corrosive sublimate, i in 500) all 
constitute our best treatment. For collections of small dimensions, we 
ordinarily use an iodine injection or needle cauterization. 

The old practice, which consisted in plugging the cavity with oakum, 
must be put aside. But, like Adam, one may, in some cases resort to 
antiseptic plugging, incise the pouch, empty it, remove the clots that it 
contains, and fill it with carbolated cotton dusted with iodoform. 

Among cattle, one most often meets with the primitive effusion of 
serosity on the external face of the stifle (Trinchera, Eletti, Furlanetto). 

Sometimes the serous collection appears voluminous, at others the 
growth is slow and gradual. In the beginning, its characteristics are 
the same as among solipeds : when it lasts a certain time, its walls 
indurate. Spontaneous absorption is observed only in recent and small 
collections. 

It is easy to differentiate these subcutaneous sero-sanguineous col- 
lections from the hydarthrosis of the stifle. 

The therapeutics is the same as in the case of horses. Notwith- 
standing Furlanetto recommends the application of ointment of bi- 
chromate of potassium, one may have recourse immediately to incision, 
apply a drain, and make irritant injections into the cavity, in preference 
to strong antiseptic solutions. 

SECTION II. 
I. 

CHILBLAINS— FROST-BITES— CONGELATIONS. 

The action of cold upon the organism ordinarily produces chil- 
blains towards extremitie's — legs, ears, tail. It can also give rise to 
general troubles and sudden death. 

In animals, chilblains are seen only during severe winters. During 
the cold season, the skin of solipeds is covered with a thick coat of 
hair, which not only protects them against atmospheric low tempera- 
tures but also prevents the loss of organic heat. 

The horse which receives sufficient food, and which has a full hairy 
coating, possesses a very great resistance to cold. In Algeria, during 
the winter of 1845-1846, during an expedition into the mountains of 



CHILBLAINS — FKOST-IUTKS— CONGELATIONS. I 55 

Bou-Taleb, about a quarter of the men of a regiment died from cold, 
while the horses suffered no accident, though they camped in the full 
wind. In Crimea, where the horses of this same regiment had to stand, 
at Kamieche, a temperature of — 18-22°, it was the same (Decroix). 
But upon horses deprived of food, cold may produce severe frost-bites 
and fatal accidents. ^ — The various breeds are not equally sensitive to 
low temperatures. During the Crimean war, Arabs' barb horses resisted 
cold a great deal better than English, and the severe winter of 1870- 
187 1 was less fatal to African than to French horses. Clipping reduces 
very much the resistance of solipeds to cold (Wolf). — In cattle, chil- 
blains of the scrotum and of the skin of the interior part of the legs are 
often observed (Stottmeister, Moller); they also occur on the paws of 
dogs and the claws, ears and the comb of fowls. 

Moist cold acts more severely than dry. On that account, in all 
species, congelations of the extremities are much more common. The 
effects of long action of ice-\vater, snow or cold mud, upon the lower 
regions of the legs are well known. In horses these effects are often 
manifested by a more or less extensive gangrene of the skin of the 
coronet, fetlock or canon. We may remark, however, that this trouble 
is very much favored by preexisting traumatic lesions ; and that, often, 
the cold is assisted by an infectious process (V. Gaugreiious Dermatitis). 
Notwithstanding the sub-horny tegumentary membrane of the foot of 
horses is so well protected, it may be affected by the cold, as is proven 
by the facts recorded during the Russo-Turkish war (Jewsejenko). 
This membrane becomes inflamed and rapidly necrosed at the point of 
the solutions of continuity, when it is exposed on those points to the 
action of snow or cold mud. 

There are three degrees of local frost-bites, as of burns. In the 
Jirst, the skin is thickened and congested; in all white-skinned animals 
and in horses, in the region where the skin has no pigment, it is of a 
purplish red color and the subcutaneous tissue is infiltrated : in the 
second, the epidermis, raised by a citrine or bloody serosity, becomes 
loose and leaves exposed the tumefied, oedematous dermis, red brown 
covered with grayish ulcerations, and sometimes deeply cracked ; in 
the third, there is slough of the skin, and of a variable thickness of the 
tissues underneath ; the tegument is livid in color, covered here and 
and there with phlyctens, while in other places it is transformed into 
black or more or less discolored eschars ; at times the mortification 
extends deeply, and the sloughing of congealed parts exposes to view 
tendons, bones, large vessels and synovial membranes. In a cow 
affected with frost-bites on the four extremities, Stottmeister saw that 
the dropping of the eschars uncovered bones and articulations.* 

* The translator has observed cases in New ^'ork, when the practise of salting tlie 
-Streets after heavy snow storms was followed, where the entire skin of the inside of 



156 VETERINARY SURtilCAL THERAPEUTICS. 

Kekiler has observed a similar case in the case of a colt that had been, 
exposed for three days to severe cold. 

Congelations may be complicated with thrombosis, embolism and', 
purulent or septic infections. When the animal resists, the region 
becomes covered with fungus ulcers whose cicatrization is slow, and 
often combined with nervous troubles (neuritis, atrophy). 

During periods of severe cold, some precautions should be taken to 
prevent bad effects. The entire coat should be left on the lower regions 
of the extremities (Weber). It may be necessary to protect the animals 
with blankets. Proper food and exercise enable them to stand the 
cold well ; food gives the combustibles and the muscular contraction 
produces the heat. Where hair is missing, or where there is a 
cicatrix, the skin may be covered with a greasy substance, with glyc- 
erine, vaseline or tar, which reduces the loss of organic heat and 
cutaneous evaporations. . During thawing weather, the tissues of the 
lower parts of the legs should be protected from the action of cold mud 
by greasing the skin, the hoof and the claws, being careful, however, if 
the use of such applications is to last long, to clean the skin and its- 
hair now and then by washing them with soap and tepid water. 

The treatment of local frost-bites, whatever may be their degree, 
varies but little in its first regulations. The affected regions must be 
rubbed with a dry cloth, with snow or a cold liquid ; and afterwards be 
covered with a loose dressing or bathed with tepid lotions. It is im- 
portant not to use warm applications, and not to bring on immediately 
an active reaction ; this would be followed by an intense inflammation 
of the tegument, and sometimes by gangrene. Exposure to the fire is 
especially dangerous ; it has often produced the sphacele of tissues 
whose vitality could have been restored by proper treatment. 

In frost-bites of the first degree, when the part is warmed up, 
stimulating lotions of camphorated alcohol or warm wine are good. If 
the skin cracks, glycerine, boricated or iodoformed vaseline is used. 

The wounds found in the second degree are treated with glycerine, 
iodated glycerine, or by slight cauterizations with solutions of nitrate of 
silver gfc. Infiltrations of the sub-cutaneous cellular tissue need no 
particular attention. Punctures or incisions of the skin are injurious. 
If the region is much tumefied and the suppuration abundant, irriga- 
tions or antiseptic baths are recommended for this as well as burns. 
When the skin of a leg of a small animal or of a part of one of 
other animals has been frozen, no better treatment exists than a tepid 
water bath at 16° or 18°, the temperature being gradually raised to 
bring it after one or two hours to 38° (Moller). 

both hind legs from the groin down had sloughed and where muscles, tendons and 
bones were exposed in some animals, the entire abdominal skin sloughed, in others 
sloughing of the feet also occurred. , 



BURNS. 157 

In frost-bites of the third degree, when attempts have failed to restore 
the tissues, when they are positively sphacelated, one must wait for the 
dropping of the eschars, watching how it progresses and frequently 
washing the parts with antiseptic solutions so as to avoid the infec- 
tious complications that may occur (pyohaemia, septicaemia). Deep or 
very extensive sloughs on large animals demand the killing of the sub- 
jects. In the case of dogs and cats there are circumstances where 
amputation of a leg is performed. 

In the case of animals affected with extensive or total congelation fol- 
lowed by general disorders, one must employ first, as in cases of local 
attack, friction, with snow or cold water, then dry, and stimulating fric- 
tions. Stimulants should be given internally — coffee, tea, wine, alcohol. 
The rapid warming by exposure to fire or by staying in a warm atmos- 
phere is extremely dangerous. It promotes thrombosis, embolism, and 
fatal visceral congestions. 

II. 
BURNS. 

The lesions produced in animals by heat and caustic substances in- 
clude all degrees of gravity, from simple erythema to extensive and 
deep disorganizations, which kill in short time. 

As the result of direct action upon the tissues, of heat or of caustics, 
burns may be produced by solids, liquids or gases. Those that are 
mostly observed in large animals are due to the combustions of solids, or 
of irritant gases, and are produced by burning buildings. Not only 
great surfaces of the superficial regions are carbonized, but warm, irrit- 
ant, asphyxiating gases enter the respiratory tracts and promote a severe 
inflammation of the mucous membrane (coryza, laryngitis, bronchitis, 
pneumonia). If a great number of the animals, whose skin has thus 
been scorched, die, it is not the result of the cutaneous asphyxia, or of 
the arrest of the functions of the skin, as pretended by some authors ; 
death is most commonly due to the phlegmasia of the respiratory mem- 
brane, brought on by the irritant action of the smoke. 

Warm water, when below 100°, gives rise only to a more or less acute 
erythema ; boiling liquids — simple water, salt water, oil especially — 
produce severe burns of the skin, sometimes of the mucous membranes ; 
and the action of liquid caustics not uncommonly goes beyond the 
tegumentary structures. Dogs and cats are especially exposed to burns 
by boiling liquids. Horses and cattle are also, when they receive 
fumigations with too hot water (Rainard). Rey has often treated burns 
made by quicklime on the extremities of horses. He also recorded the 
case of a horse which had his four extremities deeply burnt with sul- 
phuric acid. Fiedeler saw two horses which had accidentally fallen 



158 VETERINARY SURGICAL THERAPEUTICS. 

in a mine upon burning scums, with their feet so burnt that even their 
shoes " had reddened with the heat." With most animals, but especially 
with horses, on which we use fire so frequently for a therapeutical object, 
burns of the skin are a possible and often serious accident. When 
the hot shoe is applied too long, on the plantar surface, during the pro- 
cess of shoeing, too much heat may be produced or the velvety tissue 
burnt. Also burns may be due to viciousness. Gohier treated a horse 
which had had his genital organs all burnt with flaming straw by his 
-cruel driver to make him start a too heavily loaded wagon. 

The gravity of burns depends on their extent and their depth, but 
above all upon the former. A circumscribed, though deep, burn seldom 
brings on fatal complications, while wide burns of the second or even 
first degree may be accompanied with congestive visceral lesions or 
septic accidents which kill after a lapse of time varying from a few days 
to several weeks. In general, when the burn has some extent, one 
ought, in order to give his prognosis, take into consideration the im- 
portance of the organs affected : skin, subcutaneous tissues, mucous 
membranes, large blood-vessels, important nervous branches, articula- 
tions, tendons and their sheaths, or organs of sense. Sometimes the 
lesions are limited to external regions ; at others the viscera or the res- 
piratory apparatus are affected. Pseudo-membranous corj'za that 
Ferrier has observed in horses that had been caught in a fire, laryngitis 
Avith oedema of the glottis, and broncho-pneumonia, are accidents 
■whose prognosis is serious. Pleuritis and pneumonia after burns of the 
-walls of the chest, peritonitis and gastro-enteritis after those of the ab- 
domen, have also been observed. The suppuration which results froni 
the sloughing of the eschars is ordinarily more abundant than in most 
other necrotic lesions. 

Burns with sloughs demand a long treatment; the sloughing of the 
mortified tissues generally requires from two to three weeks. The parts 
disorganized with fire, slough more quickly than with chemical caustics ; 
and if a comjDarison be made between those, noticeable differences will 
be observed : the eschars of corrosive sublimate are less extensive and 
drop more rapidly than those of arsenious acid. On horses burnt with 
quicklime, Rey has had to treat extensive detachments of skin, and 
wounds in which cicatrization was very difiicult to obtain. 

From a therapeutical point of view, we may consider three degrees of 
burns, In the^V^Y. there is only scorching of the hair and slight in- 
flammation of the skin ; in the scro/n/, there is phlegmasia more marked 
and a formation of vesicles or of pustules ; in the f///n/, there is carbon- 
ization of the tegumentary membrane or intense infiammation of the 
skin, sometimes of the tissues underneath, and consecutive gangrene. 

Btn-}is of the Jirst degree, when not extensive, demand only very 
simple treatment ; cold aspersions, white lotion compresses of sulphate 



BURNS. 159 

of zinc or of iron i f/, starch powder and oUier pulverized remedies. If 
pain is great, especially when a dog is the subject, cocained prepara- 
tions nuist be used, to prevent its scratching or biting. Starr ointment 
(liq. perchlo- iron, 3 parts ; vaseline 24 parts) applied at the start, 
quietens the pain and prevents the formation of phlyctenes. 

In bums of ihe second degree, the suffering is severe, and the secretion 
of the vesicles gives a painful sensation. This must be allowed to es- 
cape by "pricking '' the epidermis; but this loose epidermic membrane 
must not be destroyed, since it covers the papillary layer, insures the 
cicatrization of the lesion, and prevents suppuration. It is good after- 
wards to apply to the affected surfaces, antiseptic lotions (solution of 
boric or salicylic acid, 3-4 ff ; of creolin, 2-3 f^ ; carbolic acid, 2 f/ : 
thymic acid, 3 <^ ; of the Van Swieten). Ointment of iodoform and 
carbolic acid (iodoform, 5 grammes ; carbolic acid, 10 drops; vaseline, 
30 grammes), and phenicated glycerine (i in 10-20) spread in thin 
coatings upon the whole surface, can also be recommended. These 
agents are preferable to the salts of lead, metallic sulphates, greasy sub- 
stances, even the old oleo-calcareous liniments, so much recommended 
and used for burns of all kinds and. degrees. Absorbing powders can 
also be utilized with advantage : starch mixed with boric or salicylic 
acid 5 ic oxide of zinc, tannin and iodoform. If pains are acute, one 
should use the solution of nitrate of silver (i in 200) ; the antiseptic 
and analgesic preparation of Reclus (vaseline 50 grammes; boric acid 
5 ; antipyrine 5; iodoform i) ; the ointment of vaseline and salol 
(vaseline 50 parts; salol 4); chlorhydrate of cocaine, o gram 25 to 
o gram 30; or lanolin mixed with aristol (aristol 3 ; olive oil 20; lano- 
lin 20). The means for restraining horses from rubbing or biting and 
dogs from licking should not be neglected. 

In cases of burns on the extremities of large animals, continued 
irrigation and antiseptic baths are advantageous. In the case of dogs, 
long immersion of the paw in a tepid solution of carbolic acid, or of 
corrosive sublimate, the dusting of the inflamed surface, and a wadding 
dressing, form a treatment that gives us the best result. Sometimes, on 
large surfaces, the epidermis sloughs off, the skin suppurates, the 
patients undergo severe sufferings. In these cases, the use of anti- 
septics and analgesics is continued ; if the burn is on a leg, balneation 
is continued longer, and made oftener ; soon the pain diminishes, the 
cutaneous phlegmasia subsides, and the lymphangitis, when it exists^ 
soon disappears. 

For hums of iJic third degree, characterized by a true carboniza- 
tion of the skin, by sphacelated surfaces, or by a gangrenous phlegma- 
sia of the tegument and liie subcutaneous tissues, two things are 
necessary: assist the delimitation of the burnt or mortified tissues; 
prevent accidents or septic complications. it is also by the use of 



IbO VETERINARY SURGICAL THERAPEUTICS, 

disinfecting solutions, irrigation or baths, and antiseptic applications 
in powder, or with vaseline, that these directions are fulfilled. Prepara- 
tions of cocaine, morphine, or iodoform, are always useful to allay the 
pain. In cases where extensive cutaneous pieces are in process of 
elimination, this can be hurried with the bistoury as soon as there 
remain but little adherences. 

When once the sloughs have fallen off and the wound cleansed and 
covered with a granulating surface, treatment of burns is the same as 
that of ordinary traumas. Moist antiseptic dressings are excellent : 
but, generall}', one is satisfied by washing the granulating surface two 
or three times a day, covering it with a coat of boricated vaseline, or 
dusting it with absorbing powder (charcoal, coal-tar, boric acid, 
camphor, oxide of zinc). Sometimes complications exist, produced by 
the burn itself or brought about by the inflammation of reaction 
(necrosis of a tendon, of an aponeurosis, of a bone, opening of a joint 
or of a tendinous sheath, thrombosis of large blood-vessels, partial 
destruction of the principal nerves of a region). Severe burns of the legs 
are treated only when the diseased parts are likely to regain the use of 
these members. Large animals which are affected with lesions, and 
whose recovery must be incomplete, or end in an inferiority rendering 
them useless, are to be condemned at once. In the case of dogs and 
cats, amputation may be performed. 

Serious secondary hyperaemia of the lungs, intestines, kidneys, liver, 
or nervous centers, and septic accidents, are indicated by significant 
troubles : weakness, stupefaction, coma, acceleration of the respiration 
and circulation, depression of the pulse, hypothermia. These are 
treated with stimulants (alcohol, coffee, acetate of ammonia, subcutane- 
ous injections of ether, cafeine), and the antiseptics (sulphate of 
quinine, cresyl, camphor). It is sometimes useful to cover the patients 
with sheets dipped in an antiseptic liquid. They should be kept up on 
milk, and, if they still are willing to drink, cold diuretics should be 
added to their beverages. Animals severely burnt at fires, ordinarily, 
during the days following, suffer with inflammation of the respiratory 
mucous membrane, and, sometimes, tracheotomy has to be performed 
to relieve an acute oedematous or pseudo-membranous laryngitis. 

Transfusions of blood and injections of salt water have been recom- 
mended against the destruction of blood-corpuscles and other altera- 
tions that may affect animals suffering with extensive burns. What- 
ever the condition, extent or degree of the injury, bleeding is forbidden. 

Some burns require special treatment. Some of them are due to 
chemical substances, which must be neutralized, or the diffusion of 
■which must be prevented. After the washing of these burns, the acids 
are neutralized by the alkalines, and vice versa'. If the lesion has been 
made by an acid, an alkaline solution of carbonate of soda, or of potash. 



INSOLATION — SUNSTROKE — OVERHEAT, l6l 

is employed ; if it has been made by an alkaline, an acid solution 
(vinegar) is used. Burns from phosphorus are treated with the hydrate 
of magnesia. 

Cicatrices, which form where losses" of substance, resulting from 
burns, have occurred, remain painful for a long time ; and the situation 
of the inodular surfaces may bring on a deformation of the region. 
Such lesions on the legs always produce lameness, and the subjects can 
only be used for such services as do not require regularity of gait. 

III. 
INSOLATION— SUNSTROKE— OVERHEAT. 

Stmstroke and Overheat ?iX^ considered by most authors as two distinct 
affections. Sunstroke is principally a cerebral trouble, produced by 
the continued action of the sun's rays striking directly upon the 
cranium. According to the intensity of the cause, the symptoms are 
those of apoplexy, or of acute meningo-encephalitis. On account of 
their double cranian wall, whose tables are far apart, having between 
them vast sinuses, where air circulates quite freely, animals are less 
exposed than man. Bourges, who in High-Senegal, High-Niger, and 
Tonkin, has been with hundreds of mules and Algerian horses, has not 
seen a single case, although a number of soldiers were fatally struck. 
"The only accidents from the solar rays he observed among horses was 
circumscribed erythema. On the contrary, Jewsejenko says that he 
saw during the Russo-Turkish campaign, in Bulgaria, numerous cases 
of insolation among the Russian horses. All of a sudden the animal 
would stagger, fall on the ground, and be taken with convulsions, the 
temperature would rise to 43° C, a cold sweat would cover the body, 
and death took place sometimes in half an hour. In a dog, left for 
for several hours exposed in a hot sun, Benjamin observed rabid symp- 
toms, which subsided rapidly by simple cooling applications upon the 
cranium. Siedamgrotzky had occasion to make the autopsy of a dog 
which, having been exposed to the full sun during a very hot day in 
July, had died suddenly : he found an abundant exudation in the 
meninges, with numerous small hemorrhagic centers in the brain and 
the medulla oblongata. 

Overheating, observed principally during the summer in horses working 
hard at middaj', and in cattle and sheep which make long journeys, 
seems to be brought on by the excessive heat of the whole body. The 
temperature may reach and go above 43° C. The animals affected 
show a great anxiety. The respiration is much accelerated and 
dyspnoeic, the beatings of the heart violent and bouncing ; the pulse 
weak, and the body is covered with perspiration. If the causes of 



l62 VETERINARY SURGICAL THERAPEUTICS. 

these troubles continue their action, the sick fall and soon die in 
convulsions. 

Most of the subjects affected with over-heating have withstood to a 
high degree the influence of the solar radiation, and, in the generality 
of cases, one is in the presence of a complex morbid state in whicli, 
according to the given troubles prevailing, three forms can be recog- 
nized : I. Cerebrospinal, essentially characterized by signs of a great 
hyperjemia of the nervous centers ; 2. Cardiac and syncopic, killing by 
arrest of the heart ; 3. Pidnionary, characterized by anxiety and exces- 
sive dyspncea, which kills by asphyxia. 

Dogs fixed softly in wooden frames and exposed to the sun when 
the heat was 25" to 28° in the shade, taken after three-quarters of an 
hour with trepidation and chronic convulsions, become comatose and 
die quickly. (Vallin, Vincent. ) ' By over-work, experimentally real- 
ized in making animals walk on a mobile wheel placed in a room 
heated 50° to 60 , death takes place after an hour or so. (Laveran, 
Reynard) -. 

The experiments made by Colin upon large animals have shov^n that 
if, by exposure to the sun, the hyperaemia of the superior regions of the 
body takes place with rapidity at a degree somewhat elevated, the central 
temperature rises only slowly and in very limited proportion. On the 
contrary, in the case of small animals, the central heat reaches quickly 
the degree incompatible with life. The wool of the sheep does not 
protect him from heat any more than from cold ; in animals of this 
species which were experimented on in a yard surrounded by very 
warm walls, the central temperature did not rise much above 41^ C. \\\ 
conditions where accidents from overheating take place, the hypere- 
mia does not result except from the outside temperature : it is due also to 
the superexcitation of animal caloricity, resulting from muscular action, 
respiration, and other fundamental modifications. Overheating has 
numerous degrees and various forms, according to its effects upon a 
larger or smaller number of functions or of organs. It may extend to 
cerebral congestion, cerebro-spinal congestion, or to other visceral con- 
gestions to incipient asphyxia, anesthesia, syncope, and to other 
troubles which invite rather than exclude each other. ^ (Colin.) 

Prophylactic rules a,re suggested by the etiology. Animals must not 
be submitted to long exposure under a burning sun, or to excessive 
work in a high temperature. If they must work under a burning sun. 
their heads ought to be protected with leaves of trees, a cap, or other 
objects ad hoc. In Bulgaria, as soon as the heads of Russian horses 

1 Vallin. Bullet. Acad de Med., 1894, p. 640. 

2 Laveran & Reynard, Bull. .^cad. de Med. 1S94, p. 501. 

3 Collin, Bull. Acad, de Med., p. 2S. 



ACCIDENTS P'ROM LIGHTNING. 163 

were protected with linen caps, there were no more deaths. (Jew- 
sejenko.) 

Curative treatment consists in immediate, and, for a time, contin- 
uous care. The animal should be placed in the shade or a cool place, 
if possible. Bleeding is especially advantageous for the pulmonary 
form. Asphyxia will be prevented by subcutaneous injections of ether 
(10 to 20 grammes for large animals ; i to 2 for small) ; they should be 
renewed after an hour ; if necessarx-, artificial respiration should be 
maintained. In the cerebro-spinal congestive form abundant affusions 
of cold water on the head and neck are recommended, with flagella- 
tion and revulsive friction on the legs (spirits of turpentine, mustard). 
To lower the temperature, cold irrigations on the body, friction with 
crushed ice or cold rectal injections are advisable. If an improvement 
is manifested, and all danger seems at end, one should have recourse 
to remedies which will prevent the return of the congestive accidents 
and stimulate the elimination of organic wastes, which are the causes of 
those accidents : injections of caffeine alone or combined with those of 
ether (caffeine 4 grammes ; salicylate or benzoate of soda, 8 grammes ; 
distilled water, Q. S. to dissolve and make 20 cubic centimeters ; give 
one gramme of caffeine by injection to large animals, 5 or 10 centi- 
grammes to small) ; injection of pilocarpine (20 to 30 centigrammes in. 
the case of large and 2 to 4 in the case of small animals). 

IV. 

ACCIDENTS FROM LIGHTNING. 

Accidents from lightning occur to all species of domestic animals, 
"but more commonly to large, especially those that live in pastures. 
According to the intensity of the action of lightning, whether it acts di- 
rectly or by reflex shock, its effects vary. Sometimes animals are killed 
on the spot — some keep the position they had when struck ; others are 
thrown on the ground and remain there senseless. There are some 
which rise almost immediately, exhibiting afterwards only signs of 
stupefaction, which pass off little by little (Roloft") ; we have seen a 
dog thrown on the ground by a shock get up after a few minutes and 
return to his normal state. It showed signs of weakness and of fright, 
but they gradually disappeared. With others, the loss of the senses 
may last several hours ; and often serious troubles remain (exaltation 
of sensibility, a stumbling walk, paresis, paralysis, hemiplegy, para- 
plegy). Blindness is frequent. (Jarmer, Fischer, Ziegenbein.) In 
numerous cases, where animals have been fatally struck, a flow of blood 
from the mouth and nostrils has been seen. 

Some animals struck by lightning present no external lesion (Roloff, 
Hering, Boellmann) ; but, ordinarily, the surface of the body shows 



164 VETERINARY SURGICAL T?IERAPEUTICS. 

Circumscribed or extensive burns, regular or irregular. The skin is 
marked with lines or narrow bands, angular or in zigzag ; sometimes 
the hair is destroyed upon wide surfaces. In piebald cows, Urbain 
has seen the burns affecting only the region covered with white hair. 
Deep burns of the dermis, of the subcutaneous connective tissue, and 
of the muscles have been observed. In general the high regions of the 
body are affected — the head, neck, and withers.* 

When lightning strikes a building containing a certain number of ani- 
mals, some standing, others lying down, it is quite often the former that 
are seriously or fatally affected. In a stable of nine horses, four that 
were lying down escaped and the others were struck ; two were killed on 
the spot, two remained blind, the fifth was paralyzed (Ziegenbein.) In 
a barn in which there were seven cows and a calf, the calf became lame 
only; all the cows were killed. In 1883, in the stud of St. George's, 
six thoroughbreds were struck with lightning. The stable included six 
compartments arranged in two rows, and each contained two horses ; 
the lightning killed the animals of the first and sixth compartments ; 
spared those of the second, and killed one in the third and one in the 
fifth. No trouble was observed on those surviving, except two 
seemed to be somewhat stupefied for a day (Garcin). Sometimes the 
victims are more numerous : in 1892, at Alhowa, near Munster, light- 
ning killed 300 sheep returning to the sheepfold. 

Electric discharges are liable to produce in animals serious and, at 
times, fatal accidents. Woherling records two cases of this nature ; a 
horse, harnessed to a cab, while trotting, fell down a few moments after 
passing over a metallic plate covering the electric light wires ; it 
exhibited numbness and muscular tremblings, which subsided in a few 
hours. A mare passing over the same plate fell suddenly, killed. 
There was no burn on the surface of the body ; at the post mortem 
examination the heart was found flabby and the lungs and nervous 
centers congested. 

The principal accidents for which one may be called upon to interfere 
are : paralysis (Roloff, Barenbach, Dehaye, Ziegenbein, Steffen) ; cramps 
(Curdt) ; burns (Curdt, Roloff, Urbain, Hering, Meyerheine, Lucas) ; 
phlegmasia of mucous membranes (Boellmam, Curdt) ; ocular lesions 
(Boellmann, Lehnhardt). 

When the animal is still lying on the ground, incompletely restored to 
itself, one must try to revive its forces by dry or irritating frictions, 

* Liautard writes on the effects of lightning on horses the result of a thunder 
storm striking a breeding establishment, where one stallion remained unhurt and an- 
other, Pancoast, was found " prostrate, lying in a heap on his off-side, with profuse 
epistaxis from both nostrils ; " he exhibited symptoms of general paralysis • the 
left side of the head was principally affected. He ultimately recovered. (American 
Vet. Review, vol. 12, page 202.) 



ACCIDENTS FROM LIGHTNING. 165 

•cold aspersions, stimulating drenches (alcohol, coffee, carbonate of 
ammonia) or subcutaneous injections (ether). Burns, cutaneous and 
mucous phlegmasia, paralysis, and ocular accidents are treated accord- 
ing to the rules laid down for the therapeutics of these affections. 
Often the affected cutaneous regions affected assume a peculiar aspect. 
Sometimes hair grows no more. (Urbain. ) Upon a cow treated by 
Miiller, the burnt region, which extended from the left flank to the tail, 
■became covered with a thick epidermic horny-like layer. 



CHAPTER III. 
COMPLICATIONS OF TRAUMATIC LESIONS. 

I. 
SYNCOPE— SHOCK— LOCAL STUPOR. 

Traumatic syncope is a serious accident, appearing suddenly, and 
characterized by arrest of the beatings of the heart and a condition of 
apparent death. 

In all species, one may observe viechanical syncope, by cerebral 
anaemia, due to a very abundant hemorrhage and to the depletion of 
the circulatory system. 

Reflex syncope is very rare in animals. Goubaux has recorded one 
case seen at the clinic of Bouley. It was in a very delicate and impres- 
sionable dog suffering from a tumor of the abdominal walls. While this 
was being excised without sensible loss of blood, or compression of the 
respiratory organs, the animal was seized with a mortal syncope. (*) 
We have observed a similar case in a slut from which we were removing 
a tumor of the ventral mammal. We also witnessed another in a mare 
during ovariotomy ; the puncture of the vaginal walls and the enlarge- 
ment of the wound had been done without incident ; at the moment 
when the hand entered the abdominal cavity, the animal made very 
violent expulsive efforts ; scarcely had the removal of the first ovary 
begun when she staggered and fell lifeless : the respiration had stopped, 
the beatings of the heart were no longer perceptible, the reflexes were 
gone. Artificial respiration and titillation of the tongue having been 
made, after a few minutes, the movements of the ribs and of the heart 
reappeared. 

Mechanical syncope may be prevented by avoiding a large loss of 
blood. The treatment for both forms is that of syncope in general : 
place the head in a dependent position, excite the skin by flagellation to 
stimulate the return of the cardial movements, practice artificial respira- 
tion, make tractions upon the tongue, and inject ether subcutaneously. 

The traumatic shock, lethargy, or stupor of the 7vounded is a condition 
of collapse which differs from syncope in the fact that the beatings of 

(*) Goubaux — Rec. de Med. Vet. 1885, p. 220. 
166 



HEMORRHAGE AND TRAUMATIC ANEMIA. 16/ 

the heart and the pulse persist. A reflex condition produced by a kind 
of commotion upon the nervous centers, the shock is often but the first 
step towards fatal coma. 

The wounded, upon which it is observed, should be left in costal 
decubitus with the head dependent. They should receive irritating 
cutaneous friction, alcohol or ether in hypodermic injections, and 
stimulating douches. 

Local stupor or traumatic local commotion, a peculiar condition 
observed with contused wounds, is characterized by anaesthesia, the 
absence of hemorrhage and the cold sensation received by feeling the 
edges of the wound. Sometimes it exists alone, at other times it is 
accompanied with the general phenomena which constitute the traumatic 
shock. Round the wound there exists a benumbed zone, ordinarily 
extensive, which has a great tendency to mortification. 

The treatment must have for its object the prevention of this, the 
arousing of the circulation, and the restoration of vitality to the anatom- 
ical elements. Stimulating and tepid antiseptic lotions are particularly 
to be recommended. As long as the local stupor lasts, all surgical 
interference must be stopped, except in case of positive emergency. 

II. 

HEMORRHAGE AND TRAUMATIC ANEMIA. 

The abundant and continued hemorrhages that are observed with some 
traumatic lesions in animals, are not always in proportion to the caliber 
of the blood-vessels divided. Whether primitive or secondary, and 
in the latter case, precocious or tardy, they may result from an alteration 
of the vascular walls, a general morbid condition (leucoemia, hemophilia) 
or from various visceral affections (diseases of the liver or of the heart). 
Their effects depend upon numerous conditions : duration and quantity 
of the hemorrhage, its local or general cause, caliber of the injured 
vessels. With the exception of patients suffering from leucaemia or 
adcnic, it is extremely rare for animals to have fatal traumatic hemorrhages, 
unless the injured blood-vessels are of great dimensions. 

The means to use in these cases vary accordingly. The flow of blood 
from small blood-vessels ordinarily subsides by plugging, pressure, or 
cauterization. For large blood-vessels, ligature or the torsion is used. 
(See Hemostasis). 

Traumatic aticernia is the consequence of the loss of a large 
quantity of blood. Sudden and considerable hemorrhages give rise to 
■acute anccmia \ less abundant but repeated flows bring on chronic 
■a/uemia. 

The complete obliteration of the bleeding vessels is, in all cases, the 



l68 VETERINARY SURGICAL THERAPEUTICS. 

first matter for interference. When anaemia occurs suddenly the^ 
serious symptoms which appear indicate an imminent syncope, whicii 
■must be prevented by placing the head of the animal in a dependent 
position, and practising flagellation and artificial respiration. Hypo- 
dermic injections of ether are also recommended. If one succeeds in 
bringing the subject to, water should be freely given to satisfy the great 
thirst which it will exhibit. Well-regulated hygienic measures, heavy 
feeding and tonics will be sufficient, generally, for a complete recovery. 
When once hemostasis is assured, tonics and abundant feeding must 
be resorted to in cases of chronic anaemia. 

III. 
TRAUMATIC EMPHYSEMA. 

Produced by the infiltration into the cellular tissue of air or of gas. 
from the digestive tracts, traumatic emphysema is characterized by a 
soft, circumscribed or diffuse tumefaction, crepitant and painless. It 
is quite frequently observed as a complication of narrow penetrating- 
wounds of the nasal cavities, sinuses, larynx, trachea, lungs or costal 
walls ; and also has been seen after wounds of the larynx, which were 
made through the mouth, in rough manipulations to push forward for- 
eign bodies arrested in the oesophagus (Barbotte) : under the influence 
of the respiratory movements, the air enters the subcutaneous or sub- 
mucous cellular tissue, spreads little by little, and makes the charac- 
teristic crepitating tumefaction. Wounds of the axilla or of the groin, 
and some peri-articular solutions of continuity, are often accompanied 
with it and sometimes with general emphysema. The patient men- 
tioned by Bouret had a wound on the inner face of the elbow : he 
became enormous, monstrous ; his limbs had the size of a child's body :. 
his body was as if it had been inflated ; the neck and all the superior 
and posterior parts of the head were in this condition. In these wounds, 
of the axilla and of the groin the edges of the solution of continuity 
separate by the motions due to abduction of the leg, the air enters by a 
kind of aspiration ; and by a motion due to adduction, it is squeezed 
into the connective tissue of the surrounding parts. Analogous pheno- 
mena take place with peri-articular wounds. 

The subcutaneous emphysema of sheep, quite frequent in animals, 
traveling in flocks, is almost always the result of penetrating bites on 
the neck ; the trachea opens, the air is pushed into the subcutaneous 
connective tissue by the action of the lung, the emphysema appears 
successively in the throat, the cheeks, forehead, and round the eyes ^ 
it extends to other regions where the looseness of the cellular tissue- 
permits the progression of the air, and in a few hours is generalized 



TRAUMATIC EMPHYSEMA. 1 69 

(Godbille). In tympanitis, if one punctures the caecum in Iiorses or 
the rumen in cattle, as also in accidental wounds of those cavities, gases, 
which they contain, penetrate sometimes into the subcutaneous con- 
nective tissue and produce a more or less extensive emphysema. 

Subcutaneous emphysema may exist without a wound of the skin or 
of the superior respiratory organs. In'cattle, it quite frequently coexists 
with pulmonary emphysema, sometimes with echinococcosis or other 
pulmonary lesions. Then, generally, it begins at the superior part on 
the neck ; ordinarily, not very apparent at the outset, palpation is 
necessary to detect it. Then it spreads towards the posterior regions, 
following the dorso-lumbar line. 

Sometimes subcutaneous emphysema shows itself upon animals 
which are not affected with pulmonary lesions and in which the skin is 
free from the perforation of oestri. This form is ordinarily observed 
upon animals which have made a long journey on foot. Cattle dealers 
say that over-walking, fatigue, and blows are the cause of it. The 
gaseous infiltration starts almost always at the loins, extending after- 
wards to the back and the withers. Lafosse admitted that under the 
influence of a trouble in the cutaneous respiration, these gases (oxygen, 
carbonic acid, nitrogen) were " thrown into the cellular tissue by the 
capillaries." Bouley had to make a fissure in the rectum with a punc- 
turing foreign body to produce it. A gaseous elaboration of microbian 
origin has also been cited as cause. 

The slight gravity of traumatic subcutaneous emphysema is recognized 
by numerous observations. The action of the air upon the cellular 
tissue is almost without danger, and that of gases issuing from intestinal 
sources is not to be feared, unless they carry with them, in the con- 
nective tissue surrounding the wound, a certain quantity of liquid mat- 
ter noxious on account of the microbes it contains. 

The treatment is the very simplest. Traumatic emphysema due to 
atmospheric air should be treated by methodic pressures made upon the 
tumefaction, from the periphery towards the wound, to expel the air 
which has penetrated the tissues. If the cutaneous wound is small, it 
should be obliterated with a plaster of collodion. Large wounds of the 
axilla and of the groin should be partially closed with a suture and the 
patient should be kept at rest. With large penetrating wounds of the 
trachea, when the air reaches the connective tissue through the wound 
of the mucous membrane it is necessary to enlarge the cutaneous solu- 
tion of continuity, whose small size is, ordinarily, the cause of the 
emphysema. In these first varieties of the affection, no puncture or 
scarification of the crepitating zone is to be made. When emphysema 
is produced by gases from intestinal cavities, the cutaneous wound must 
be enlarged, methodic pressures must be made on the swelling, and if 
the inflammation of the peritraumatic zone indicates the presence, in 



I/O VETERINARY SURGICAL THERAPEUTICS. 

the tissues, of irritant infectious liquids, scarifications and antiseptic 
injections must be made. Emphysema of sheep can be avoided by 
smoothing the canine teeth of dogs which watch the flock. When a 
bite is already accompanied with emphysema, a free cutting away of 
the skin, at the wound, will prevent its spreading. 

The benignity of essential emphysema is like that of localized em- 
physema. It ordinarily disappears in a few days, sometimes even iu 
a few hours. Massage is useful. Scarifications, recommended by 
Lafosse, are superfluous. 

IV. 

THROMBOSIS AND TRAUMATIC VENOUS EMBOLISM. 

Any vein enclosed in a traumatic center is exposed to thrombosis ; 
inflammation may al^ect its walls, alter its endothelial layer, and thus 
produce coagulation of the blood in the blood-vessel ; if the walls 
have been injured, thrombosis almost always starts immediately. Some- 
times the clot increases gradually, obliterates the vessel, and extends 
forward even to the first collateral {obliterating thrombosis) ; at other 
times the coagulation remains still and the canal is yet permeable {pa- 
rietal thrombosis). When the diseased vein is enclosed in a non-infected 
traumatic center, the intravascular clot is also aseptic. It is habitu- 
ally infected in venous thrombosis which occurs in suppurating wounds. 

In general, aseptic clots quickly adhere somewhat intimately to the 
walls of the blood-vessel ; they are soon infiltrated with embryonic 
elements, and become the seat of an organization which ends with the 
obliteration of the vein by a fibrous tissue continuous with the vascular 
walls. Sometimes it happens that they disintegrate ; portions may get 
loose from their central extremity, continuously struck by the blood at 
the very point where the circulation is still going on. 

It is thus that, emboli or erratic clots are produced, which, carried by 
the blood, go to produce infarction in the lungs, by obliterating the 
small divisions of the pulmonary artery. Unless voluminous, aseptic 
emboli give rise to troubles, not serious, beginning in hypera;mia and 
ending in sclerosis of the thrombotic pulmonary territory. What 
makes the gravity of traumatic thrombi, or of the emboli that get loose 
from them or of the infarctions which produce them, is infection. Septic 
or nialignaut emboli carry into the lungs infectious agents with various 
virulency which give rise to metastatic abscesses or to centers for gan- 
grene. 

Voluminous emboli sometimes close a principal branch of the pulmo- 
nary artery ; at others, they are arrested by the valvular cords of the 
right ventricle. Whether aseptic or infected, they suddenly provoke 
serious troubles, sometimes death in a few moments. 



TRAUMATIC FEVER. I/I 

When an important vein is enclosed in a traumatic center or included 
in its walls, and by this fact exposed to thrombosis ; and when the 
latter is already realized, one must insure the immobilization of the re- 
gion, avoid explorations and useless pressures, attend to the correct ap- 
plication of the dressings or necessary bandaging, and prevent the 
phlogogenous action of the secretions of the wound and of the pus 
upon the venous walls. Such are the general requirements. With pu- 
rulent thrombosis of some superficial veins, immediate ligature, made 
aseptically at some distance from the morbid center, is the surest way 
to prevent infectious complications. 

V. 
TRAUMATIC FEVER. 

The febrile reaction which occurs in subjects wounded and operated 
upon is due sometimes to absorption, from the traumatic center, of 
pyrogenous or septic substances (traumatic fever proper), at others, to 
a secondary local affection or a diathetic determination, both provoked 
by the wound (epitraumatic fever). 

Ordinary traumatic fever appears, generally, the second or third day, 
reaches a variable degree of intensity, according as it is aseptic or septic, 
remains stationary for two or tiiree days, then gradually subsides, to 
disappear from the fifth to the eighth day. After accidental wounds or 
those from operations made in infected tissues, it often manifests itself 
in twenty-four hours, the pyrogenous substances of the wound being 
immediately absorbed. Although the fever is slight with traumas which 
cicatrize by first intention, it is sometimes severe when the wounds are 
extensive, deep and suppurating, and when violent inflammatory pheno- 
mena occur, due to the presence of a body foreign to the wound, to a 
necrosis, or a local gangrene. Any complication which occurs in a 
trauma is, in general, indicated by a sudden ascension of the thermic 
curve and an increase of the other phenomena of reaction. The theory 
which explains traumatic fever by the absorption of the inflammatory 
or septic products, to-day universally adopted, is based upon the fol- 
lowing data : the puUulation on the wound of various microbes, in par- 
ticular of the agents of suppuration, brings on the elaboration of pyro- 
genous leucomaines absorbed by the tissues ;— with antisepsis, there is 
no traumatic fever, or it is very weak ; when it is observed in wounded 
animals whose wounds cicatrize by first intention, protected by antiseptic 
dressings, or after subcutaneous lesions, it is almost always slight; — in 
animals, septic traumatic fever is indicated by a hyperthermia of two or 
three degrees ; in aseptic febrile reactions, the mercurial column does 
not rise much above 39°. Notwithstanding the results obtained by the 
well-known experiment of Claude Bernard from the deep puncture by a 



172 VETERINARY SURGICAL THERAPEUTICS. 

street nail made on a horse's foot and other researches of the same kind, 
the part which the nervous system plays in the genesis of traumatic, 
febrile action is secondary. 

The prophylaxis of surgical fevers depends altogether upon antisep- 
sis. With it we can, henceforth, screen our patients operated upon and 
our wounded from those intoxications, considered in days gone by as 
fatal, which result from the absorption of putrid liquids collected on the 
exposed wounds or under the dressings. All operation on healthy 
tissues, performed aseptically, ought not to be accompanied by other 
than benignant phenomena of reaction and a moderate hyperthermia. If 
it is made on inflamed, suppurating tissues, one should reduce to the 
minimum the febrile manifestations, by minutely disinfecting the wound 
and its surroundings (washings, baths) previous to the act of operating; 
the diereses made with the red hot wire expose these lesions less to ab- 
sorption of putrid matter and to intoxication than those made with the 
bistoury. Nothing demonstrates more forcibly the influence of anti- 
sepsis upon the degree of the traumatic pyrexia in animals than a com- 
parison of the thermic curves taken upon subjects of an operation whose 
wound had been covered with a wadded dressing, or with one of oakum, 
not disinfected. We may remark, however, that even in operations and 
dressings made as they should be, one does not always succeed in pre- 
venting a somewhat marked elevation of temperature. At times, with 
subjects whose general condition and the great functions are scarcely 
disturbed, one will observe thermic ascensions which reach 1.5°, without 
manifest complication from the wound, bat these cases are exceptional ; 
general troubles are ordinarily in proportion to the hyperthermia ; and 
when the mercury reaches 39.5°, it is wise to remove the dressing and 
look. For the same reason, if the fever does not subside by the eighth, 
or the tenth day, often, there is an accumulation of pus or of putrid 
serosity in the wound, when a local gangrenous or necrotic complication, 
has not already taken place. The irrigation of the trauma with an an- 
tiseptic solution (carbolic acid.creolin or chloride of zinc) is sufficient to- 
lower the temperature, sometimes to bring it back to a figure close to 
normal. 

W^ith exposed wounds, the same result may be obtained by disinfec- 
tion, and free escape of the secretions, draining, and the use of absorb- 
ing powders. The flow of the liquids being insured, if the fever con- 
tinues to be high, all there is to do is to increase the antiseptic washings 
and watch the surroundings of the wound ; sometimes the phlegmasia, 
is very high, at others a phlegmon or lymphangitis is developing. 

The internal treatment is that of fever in general. We generally 
prescribe only slight purgative alkalines. Surgical fevers, however,, 
being attenuated forms of putrid intoxication, it may be a good things 
if they are severe, to have recourse to antiseptics and antipyretics. 



TRAUMATIC ERYSIPELAS. 173 

(salicylic acid, creolin, camphor, antipyrine). In some cases the weak- 
ness and depression of the animals will have to be treated with stimu- 
lants (coffee, alcohol, ether). 

VI. 
TRAUMATIC ERYSIPELAS. 

Erysipelas is scarcely ever observed in animals. It is, however, an 
infectious complication of wounds, produced by a streptococcus con- 
sidered at first as a specific microbe. The infectious agent penetrates 
the walls of the wound, reaches its cavity little by little, progresses into 
the lymphatics, at times promotes phlegmous or local gangrenous acci- 
dents, and may even produce serious general accidents, fatal serous or 
visceral phlegmasia. Ordinarily, erysipelas is a complication of recent 
wounds of the skin and of the mucous membranes; it is with contused 
wounds, burns, and lesions resulting from some cutaneous diseases 
(acne, eczema, follicular mange) that it is observed most commonly ;, 
but any solution of continuity of the skin is favorable to its develop- 
ment ; a simple excoriation is sufficient for its appearance. It also often 
appears with wounds already granulating, when this protecting cover is 
accidentally torn ; it is thus that erysipelas is seen with ulcers, suppu- 
rating wounds, or old fistulas (auto-inoculation). 

The pathogenous element has been isolated in man by Fehleisen.. 
]t is a streptococcus arranged in double chains, which grows well on 
gelatine and on agar, where it forms whitish colonies. It does not 
liquefy gelatine. Most barteriologists doubt its specificness, and claim 
that it is the ordinary streptococcus. To this, it is objected that the in- 
oculation of pure cultures of the streptococcus of Fehleisen promotes- 
erysipelas with or without lymphangitis, while the ordinary streptococ- 
cus engenders phlegmons especially. But it is now known that the 
streptococcus, like many other pathogenous germs, may promote diverse 
affections, very different troubles according to its actual degree of 
malignity or of virulency. Very often the agent of erysipelas does not 
act alone; it is associated with other microbes, most frequently with 
staphylococci. The disease is contagious and is easily transmitted by the 
hands, instruments, and materials for dressings. Before antisepsis, be- 
fore the researches whicli have definitively proved its infectious nature, 
it has frequently been seen prevailing as an epidemic in hospitals for 
mankind. In veterinary practice, a great number of affections liave 
been described under the name of erysipelas. The reading of tiie 
published observations shows that under this title have been ranged: 
the erythemas produced by the sun or the eating of buckwheat, the 
cutaneous quittor, anthrax, rouget and even eczema. With the excep- 



174 VETERINARY SURGICAL THERAPEUTICS. 

tion of a few recent facts, all were falsely named, or they do not posses.-; 
the stamp of exactitude demanded in scientific researches. No doubt, 
however, erysipelas exists in animals. It is inoculable by subjects of 
our domestic species ; Fehleisen has studied it experimentally on 
swine and on rabbits ; Moller, Hoffman, and Lucet have seen it on the 
horse ; Rychner and Lucet on cattle ; Frohner on dogs (4 cases only 
out of about 70,000 patients).' We ourselves have seen it several 
times on horses and in dogs. The principal characteristics of cutane- 
ous erysipelas, since they are concealed by the hair, and, in the case 
of the horse, by the pigment of the skin, are much less evident than in 
man. That is why, in veterinary practice, it has been mistaken to this 
day with phlegmon, lymphangitis or the septic processes. In general, 
it seems less serious in animals than in man ; fatal cases, however, 
have been noted in the case of dogs and solipeds. Upon the horse of 
Lucet, erysipelas acted like septicaemia and killed it in forty-eight 
hours. 

The prophylaxis of erysipelas from operations is that of all infec- 
tious accidents which may complicate wounds made by the surgeon. 
Operate quickly, take all antiseptic precautions, protect the wound 
against post-operatory infection. Those are the means. But it is not 
so easy to prevent them with old accidental wounds, infected and sup- 
purating. Although these can be cleansed, even their dressings re- 
newed without tearing the granulations when they are enlarged or 
treated with the bistoury, new roads of entrance are necessarily opened 
to the micro-organisms. The chances of infection will be reduced to 
the minimum by previously washing the granulating surfaces and ex- 
cisii^g them with the red-hot cautery. 

When the erysipelas is developed, the treatment must be local and 
internal. If it is limited to the peritraumatic zone, tepid carbolic or 
corrosive sublimate solutions, used as lotions, irrigations, baths or 
nebulizations, according to the case, then followed by applications of 
boricated or cocained vaseline, are almost always sufficient to prevent 
its extension — often they have a beneficial action on the general con- 
dition ; and soon the temperature lowers. The same treatment should 
be carried out if there are phyctenes or lymphangitis. With erysipe- 
latous wounds of the extremities, combined with lymphangitis and 
diffuse swelling of the extremities, long antiseptic baths (solution of cor- 
rosive sublimate, i in 1,000, or of carbolic acid 2 f/, are very advan- 
tageous. 

Phkgnionons erysipelas must be treated more actively. When a 
severe oedematous tumefaction announces the inflammation of the sub- 
cutaneous connective tissue, one must make, over the whole involved 

1 Frohner, Herlin. Tliieiarztl Wochurschr, 1S94, p. 368. 



PURULENT INFECTION — PYOII^MIA. 175 

surface, scarifications or deep cauterizalions which permit the exit of 
the inflammatory exudation and open to antiseptics admission to the 
deep layer of the dermis, the subcutaneous region and the lymphatic 
radicules where streptococci are niuuerous. As soon as fluctuation 
indicates the presence of abscesses in the neighborhood of the wounds, 
along the lymphatic vessels or in their glands, these abscesses must 
be immediately opened and treated antiseptically. Diffuse swellings, 
which sometimes occur on the legs, should be carefully watched, and if 
the formation of deep abscesses is suspected they should be probed 
with fine punctures. Scarifications or deep point firing, tepid antisep- 
tic irrigations or baths are still the best means to prevent gangrene of 
highly inflamed tissues ; if, however, sloughs take place, the treatment 
should be completed by that for moist gangrene. 

Complications of the viscera, of the large serous membranes, and of 
articulations are treated by methods especially marked out for each of 
those. 

Slight cases receive for general treatment tonic douches, light 
purgatives or alkalines. The other cases receive antiseptics, alcohol, 
extract of cinchona, and sulphate of quinine, according to the species 
under treatment. 



vir. 

PURULENT INFECTION— PYOH/EMIA. 

Produced by the penetration of pyogenic microbes into the circula- 
tion and their diffusion through the organism, purulent infection — ■ 
^yohcemia — is a complication of suppurative wounds. While septicae- 
mia is ordinarily a precocious accident of traumas, pyohasmia is a late 
episode of the same, but not the less dangerous. Likely to occur in all 
species, particularly common in horses, rather rare in dogs, swine and 
sheep, it is exceptional in cattle, goats and birds. 

It may break out at any moment with extensive, deep, anfractuous 
wounds, which suppurate abundantly ; with sinuous fistulas, having 
several tracts which present necrotic lesions of synovial membranes, 
tendons and bones ; with suppuration of the synovial membranes ; or 
with suppurative inflammation of the veins or of the lymphatic trunks. 
In horses, phlebitis of the jugular, poll-evils, disease of the withers, 
tendinous quittor, purulent arthritis and synovitis, gangrene of the 
tegumentary membrane of the foot and the caries of the as pedis are the 
surgical affections which are mostly accompanied by it. Independently 
of the ordinary purulent absorption, there exists in that species specific 
pyoha;mias related to some infections (distemper, glanders). In 
cattle, it has been observed as a complication of extensive suppurating 



1/6 VETERINARY SURGICAL THERAPEUTICS. 

contused wounds ; most commonly, it has as starting point several 
external phlegmasias related to somt infection and carrying with itself 
gangrenous or necrotic lesions (aphthous fever). The same thing occurs 
in small ruminants. In dogs, its ordinary causes are complicated 
fractures, crushings, and other traumatic lesions of the bones of 
the extremities. In young animals of any species, more especially 
colts and calves, it is almost always due to the suppurative inflam- 
mation of the umbilical vein, phlebitis of the cord. 

Its etiology consists in the existence of a suppurating trauma , several 
conditions, however, inherent in this, in the wounded subject, and in 
the surroundings, promote its development ; these are especially : the 
depth of the wound, its anfractuous conditions, the underminings in 
which the pus collects, the generally bad state of health, the heaviness 
and the overworked condition of the patient, the want of ventilation 
and defective hygienic surroundings in which the animal is placed. 

Purulent infection is produced by the ordinary microbes of suppura- 
tion, generally streptococci or staphylococci. The most constant of 
those, the one that plays the greatest part, is the ordinary (vulgar) 
streptococcus. It acts alone or in concert with staphylococci. It is 
known that the latter possess various degrees of virulency, and that, 
alone, they may give rise to pyohamia ; but cases of this kind are 
rare. In three cases of purulent infection studied by us from the 
bacteriological point of view, we have twice found streptococci and 
once associated with staphylococci. 

How do those microbes reach the blood ? By what mechanism can 
they promote the metastatic abscesses and the other lesions of pyoha;- 
mia? The mode of infection, very different in different cases, is ofteu 
complex. With suppurative phlebitis, infecting emboli may get de- 
tached from the intra-venous clot which is infected with pyogenic 
microbes, and be carried by the blood into the lungs and other organs. 
Within the walls of fistulous tracts, due to and kept up by necrotic 
lesions (disease of the withers, of the neck, tendinous quittor), there 
'exist phlebitis and lymphangitis from which the infection may start. 
"Without phlebitis in old suppurating wounds the granulating surface 
may be torn ; " the wound is wounded " in one place ; there the tissues 
are no longer protected by their guarding cover, and the blood and 
lymphatic vascular canals are open to the agents of suppuration. The 
modifications presented by purulent infection in its mode of expression, 
its march and gravity, are especially due to the variable virulency of the 
microbian species which produce it. 

The propyhlaxis demands the same general precautions as that of 
septicaemia. It is by the wound that the pyogenic microbes penetrated 
Into the economy ; so that careful attention must be given to the 
'wound to prevent infection. With wide, deep, irregular wounds, one 



PURULENT INFECTION — PVOH^MIA. 1 7/ 

Tiiiust avoid the stagnation of the pus. Frequent antiseptic washes and 
•continued irrigation are the best means to use. Often enlarging 
incisions, counter-openings and drainage have to be made ; though one 
•ought, in a general way, to avoid the wounding of granulating layers ; 
there should be no hesitation, however, if the case is urgent. The red 
hot iron, a sharp or a long pointed cautery, is better than the bistoury : 
the eschar remains adherent to the tissues underneath until they are 
lined with granulations, the penetration of the micro-organisms cannot 
take place as upon bleeding surfaces. The washings should be com- 
pleted by irrigations with an antiseptic solution, sufficiently strong to 
destroy the germs still adherent to the granulations. 

For anfractuous wounds, carbolic or corrosive sublimate nebuliza- 
lion are very advantageous. If they exist on the legs, long tepid anti- 
septic baths of twenty minutes or half an hour and repeated several 
times a day should be prescribed. Antiseptic or simply absorbing 
powders may also be useful. 

Attention to hygiene should not be overlooked : spacious, well 
ventilated, moderately warm locality ; food of good quality : for weak 
patients, if appetite remains, abundant feeding, milk, tonics, a stim- 
ulant (alcohol, hay tea). 

The outset of pyohsemia is slow. Often the wound is but little 
■changed ; the granulations are pale, soft, flabby, and suppuration is less 
abundant ; but there is no other prominent symptom, no diffuse tume- 
faction, no oedema. As to general disturbances, they are those of a 
strong traumatic fever, with febrile rushes, chills, sudden thermic 
risings, inappetency, dulness, a kind of typhoid condition with dull 
coloration of the mucous membranes and an irregular pulse ; their mean- 
ing is positive, even when the patient has been previously under the 
influence of a more or less marked febrile reaction. To inspect the 
wound, enlarge it, cleanse it well, sponge its cul-de-sacs with strong 
disinfecting solution (chloride of zinc, carbolic acid, corrosive subli- 
mate), dust it with iodoform and irrigate it continually with cold water. 
This must be done at once. 

Cautery is useful to destroy the fungus granulations which conceal 
putrid centers, and to reach the infectious germs deep down. To try 
to " render the wound aseptic," as advised by some, is evidently an 
illusion ; but it must be purified as much as possible. If purulent 
superficial collusions appear, they must be opened at once and treated 
as ordinary abscesses. 

The internal treatment, most uncertain in its results, consists in the 
administration of agents able to build up the strength, impede the pullu- 
lation of the microbes and neutralize the effects of their toxines. Among 
the numerous substances recommended, those that are most used are : 
alcohol, coffee, sulphate of quinine, carbolic acid, creosote, creolin, spirits 



178 VETERINARY SURGICAL THERAPEUTICS. 

of turpentine, and salicylate of soda. They are introduced niostlv 
through the digestive mucous membranes (mouth, rectum), some br 
hypodermic injections (carbolic acid, sulphate of quinine). U is better 
to administer them under the form of rectal injections than by force 
through the mouth. Lately, hypodermic and intravenous injections of 
weak solutions of corrosive sublimate have been tried for man. While 
the first proved insufficient, the intravenous injections (30 to 40 milli- 
grammes of corrosive sublimate in 8-10 injections) by the method of 
Bacelli, have given Kermarsky several successes. It is a method which 
might be tried with animals. The patient should be kept up on tonics, 
milk, hay-tea, and soups. If anorexia is present, nutritious rectal in- 
jections should be given. 

The same as for septicaemia, when already the organism is thoroughly 
infected and intoxicated, whatever antiseptics nre used, and no matter 
what is the dose or the mode of administration, the bacterians still 
triumph. There is chance of success only at the beginning of the in- 
fection. As proof of the possibility of recovery from pyoha^mia, facts, 
it is true, have been mentioned in which, at the post-mortem examin- 
ation of some horses, caseous purulent centers, disseminated through 
the viscera, were found ; but a close study of these facts shows that 
they were of tuberculous or glanderous nature, and due to chronic 
purulent injection. We do not know that, up to this time, authentic 
cases of the cure of confirmed pyohaemia in horses, as expressed by the 
clinical signs which announce visceral infection, have ever been 
reported. 

VIII 
SURGICAL SEPTICEMIA.— TRAUMATIC GANGRENE. 

A fo'rmidable complication of traumas is surgical septicaemia, an 
infectious, microbian disease, produced by the sc/Zir I'ibrio or bacillus 
septic us gangrcnus. 

All animal species are subject to it, but all are not equally liable ; and in 
each species, all the individuals do not possess like aptitude to contract 
it. It is most frequently observed in horses, less commonly in dogs, 
swine, and ruminants ; among the latter, cattle are only exceptionally 
affected. 

Old surgery had clearly mentioned the condition in which traumatic 
septicEemia occurs. It was known that recent wounds, contused, irreg- 
ular, with crushed or sphacelated borders, were principally liable to 
it. The dangerous influence of overcrowding, limited quarters, close 
air, and atmosphere vitiated by agglomeration of the sick were all 
recognized. It is nearly a century since Barthelemy and Dupuy made 
the first experiments at Alfort to tl.rew light on the pathogeny of this 



SURGICAL SEPTICyKMTA — TRAUMATIC GANGRENE. I 79 

disease in the cases of horses. Iti 1840, Renault, after having insisted 
upon the dangers of the exposure of wounded tissues, incriminated, as 
conditions of its development, the presence in wounds of clots of blood, 
of mortified tissues, of putrefied organic matter, and the contact of those 
clots and of those tissues with the warm, damp atmosphere, loaded 
"with the " miasmas " of putrefaction. After Bottini had demonstrated 
its transmissibility, it was no longer disputed that the infection is car- 
ried, especially to accidental traumas, not by the air, but by solids and 
liquids, by contaminated objects, pus and putrid serosities, earth and 
manure. 

The researches of Chauveau and Arloing have established that the 
septic vibrio of Pasteur is the agent of the gangrenous septicaemia of the 
human and of the animal species. This anaerobiotic vibrio presents 
itself under two principal aspects : ist, under the form of rods {baton- 
nets) or of threads, more or less long and mobile; 2d, under that of 
germ-corpuscles. A completely developed adult is killed by the oxygen 
of the air and by that which liquids hold in suspension ; but the spores 
are not at all affected by this agent. If the septic elements contained 
in liquids or solid matter forming a coat of a certain thickness, are 
exposed to the air, notwithstanding the action of oxygen, the vibrios 
concealed in the depth of this coat multiply and develop spores — the 
*' vestals " of septic virulency — in spite cf oxygen and most micro- 
bicide agents. It is these spores confined in septic matters which 
constitute the agents of contagion ; after desication and disaggregation. 
of this matter, they form the septic dust, the seed which transmits every- 
where the dangerous infection. 

Fresh virulent serosity energetically resists antiseptics. The most 
powerful of those seems to be sulphurous acid. Permanganate of po- 
tassium, I in 20, only attenuates the virulency. Corrosive sublimate, i 
in 1000 or I in 500, is without action upon it. Carbolic acid, 3, 2, or even 
I in 100, destroys the dry virus after six hours' contact. Putrefaction 
kills it also. But matter dried between 15-38° C, before putrefaction 
takes hold of it, preserves its virulency for years (Chauveau &: Arloing). 

The already old experiments of Billroth, then those of Jeannel and 
Laulanie (1885) have shown that septic elements do not pass througii 
granulating membranes. Wounds entirely covered with intact granula- 
tions are protected from septicaemia. They can be sprinkled, with im- 
punity, with septic liquids, even covered afterwards with a dressing, 
and not be infected ; and though they absorb a certain quantity of 
ptomaines, no serious symptoms of poisoning appear. But, should the 
granulating membrane be chafed and the barrier that it forms be re- 
moved from any place, no matter how small, the condition is realized 
for septicaemia. The vascular apparatus, when perfect in the consti- 
tution of the walls of its numerous canals, is not very favorable ground 



l80 VETERINARY SURGICAL THERAPEUTICS. 

to the development of the septicasmic process. One may inject with 
impunity into the veins of a susceptible animal filtrated septic serosity, 
free from its figurated elements and containing only ptomaines (Chau- 
veau & Arloing). Although serosity, not filtrated, injected in rather 
large quantity, produces death with generalized lesions, which are par- 
ticularly marked in the serous membranes, small doses of this serosity. 
do no harm, providing the vascular walls have no solution of continuity 
to allow the irritation of the septic germs into the tissues ; but if a sub- 
cutaneous trauma is started in an animal in which virulent serosity has 
been injected, a septic center appears at the injured spot. We may re- 
call the celebrated experiment of the double-twisting (bistourage) 
made by Chauveau (1868), always repeated with the same results: the 
testicular traumatic center produced after the injection of the septic 
corpuscles into the general circulation became invariably the starting- 
point of a fatal septicEemic process. 

The smallest solution of continuity may be the starting-point of sep- 
ticaemia ; it occurs, however, always by preference on extensive and 
deep wounds. Its appearance is singularly excited by the contused 
condition or the ischsemia on a large surface of the injured tissues by the 
presence of cul de sacs, or anfractuosities where oxygen has difficult access, 
or by the presence of blood clots, of small spots which will gangrene or 
are already mortified. Even in recent wounds septiccemia has little show 
when the injured surface is widely exposed to the action of air, especially 
when it is submitted to continued irritation with aerated water. In 
those conditions the septic vibrios which mark its surface are destroyed 
by the oxygen and the spores remained inactive (Pasteur). 

Independently of puerpei'al sepiic(£7?iia, which is a streptococci in- 
fection (Chauveau), there are traumatic septicaemias which are not due 
to the bacillus scpticus gangreiice. These infections are produced 
by micro-organisms — some of which are known (streptococci, bacil- 
lus of Novy), while others remain to be studied. We wish only to 
mention them. 

Gaseous gangrene, more or less rapid in its progress, is announced by 
phenomena which mark it well. The suddenness of its invasion ; the se- 
vere phlegmasia which takes place round the wound and spreads rapidly 
in all directions ; the cedematous circle which binds it ; the progressive 
mortification and the putrefaction which follow it soon ; the foetid odor 
exhaled from the septic center ; the hyperthermia and the other gen- 
eral symptoms, form a clinical picture which cannot be mistaken for 
any other, at least in horses, and in most of the other species. Except- 
ing the tumor of symptomatic anthrax, which cattle have, all the other 
inflammatory, crepitating tumefactions observed in animals and pro- 
duced by different microbes have in common, together with septic 
swelling, only crepitation. 



SURGICAL SEPTICAEMIA — TRAUMATIC GANGRENE. l8r 

The prophylaxis is based upon the data of clinic and experimen- 
tation. We do not fear any longer this infection in the wounds of op- 
eration when those are made under the cover of asepsis, sewed up after- 
wards, and covered with a closing dressing. It is not much to be 
feared in wounds of operation which are exposed (castration), when the 
operation has been cleanly done by avoiding the soiling of the trauma 
with the hands, the instruments or other objects used. What is espe- 
cially dangerous, as we have said, is not the air, as it was believed by 
the promoters of antisepsis, but "the dirt" that the surgeon, careless 
or unclean, carries into the tissue during the operation. The virulency 
■of the septic matter deposited upon instruments resists the action of 
•disinfecting solution, so that to destroy it with certainty they must be 
sterilized by heat. (See Antisepsy.) 

The wounded should be placed in well-ventilated and clean-kept 
places. Gangrenous septicaemia occurs almost always in recent acci- 
dental wounds, not yet protected by the granular coat, or in contused 
traumatic lesions, anfractuous, and soiled with dust, earth, mud, and 
manure ; and those are the ones which require good watching ; they are 
those which demand especially the most minute disinfection and the free 
antiseptic irrigations. Drainage and iodoform plugging are very useful 
for deep traumas which, in certain regions (chest, axilla, groin, per- 
ineum), extend deep into the cellular layers infected with blood and 
serosity where the germs of the frightful gangrene collect and multiply 
with a fearful rapidity. The researches of Forgue have taught us that 
iodoform is the surest agent for destroying them. One should prevent 
the gatherings into the center of the wound — into its shallows and its 
out-of-the-way corners — of clots of blood and of secreted liquids ; wash- 
ings with solutions of carbolic acid, permanganate of potassium, iodine, 
and chloride of zinc should be made. Concentrated alcohol and the 
tinctures have been advised to create, on the surface of the wound, by 
the coagulation of the albuminous liquids, an isloating coat imper- 
vious to septic liquids. The strong^solution of carbolic acid acts in the 
same way. Continued irrigation or washes frequently made take away 
the products of the secretion of wounds, interfere, by the action of ox- 
ygen, with the evolution of the vibrios, and prevent their entrance 
into the tissues. Sometimes injection appears in wounds already old 
and protected for a long time by a layer of granulations when they have 
been opened by an incision or by tearing; therefore, injuries to these 
granular covers must be avoided as much as possible. 

When septicaemia has appeared, so that already the wound is sur- 
rounded by a tense swelling, crepitating, and oedematous on its borders 
— what means are to be used? In veterinary as in surgery for man- 
kind the disease is said to be incurable and all therapeutics useless. 
But as serious as gaseous gangrene may be, when it has not yet ex- 



l82 VETERFNARY SURGICAL THERAPEUTICS. 

tended over a large surface, where it is limited to a region regular in its 
external conformation and formed of muscular layers, when its evolu- 
tion is not "fulminating," and when the organism is not seriously intoxi- 
cated, art is not disarmed ; a powerful intervention may yet be fol- 
lowed by success. It must be acknowledged, however, that the number 
of recoveries has been exaggerated, by reporting, under the name of 
" septic gangrene," oedematous or crepitating tumefactions which had 
nothing septicaemic in their nature. 

Every subject affected with septicaemia must be placed in a place 
where the air can be frequently changed and where the fioor and walls. 
can be sprinkled with disinfecting volatile liquids : the antiseptic vapors, 
will spread in the air, penetrate into the organisms by the lungs, and 
may act favorably against incipient intoxication. 

Excision of the aseptic tissues with the knife is a process that we da 
not recommend. It is always difFcult, and often impossible to mark 
the correct line of demarcation ; the w^ound thus produced has often a 
great extension and depth ; and no matter how large the ablation may 
be, there almost always remains an infected zone, the ground occupied 
by the bacilli extending beyond the marks made by the surgeon. Inter- 
ference should consist in deep, numerous scarifications made on all the 
contaminated surface and a little beyond its outlines. The cautery is 
to be preferred to the bistoury to make them. These scarifications allow 
the escape of putrid liquids and gases accumulated in the sphacelated 
parts, and of the serosity gathered in the oedematous region. After- 
wards should follow, several hours apart, antiseptic injections of a: 
strong solution of carbolic acid, corrosive sublimate, or permanganate 
of potassium, which, thus carried directly into the bottom of the infected 
tissues, may arrest the pullulation of the septic agents. A long trocar 
may be used to make them penetrate deeply. The entire surface of 
the gangrenous center must also be irrigated with the disinfecting liquid.. 

Trasbot finds the best local treatment of septicaemia in cauterization 
in points quite large and deeply penetrating into the septic swelling, 
with injections of tincture of iodine two or three times a day into the 
points, and iodine coatings painted with a brush over the invaded 
region. Many times has it been " very efficacious '' in one of the most 
dangerous forms of traumatic gangrene. 

The introduction into the circulation of the toxic substances elaborated 
on the gangrenous surface produces an increasing depression in the pa- 
tient. If it is yet willing to take liquids let them be added to these diffusible 
stimulants (wine, alcohol) or antiseptics (cresyl, carbolic acid, camphor,, 
tannin, cinchona). If not, those medicaments should be administered 
through the rectum. Cresyl, naphtaline, and subnitrate of bismuth 
are useful in septic diarrhoea. Subcutaneous injections of ether or of 
caffeine should be prescribed if the heart is weak. 



PUTRID INFECTION— CHRONIC SEPTICEMIA. 183 

In cases where the diseased process is recent, there is some hope of 
recovery ; but as soon as an extensive territory is invaded by the 
bacilli, the infection is generalized, and the organism deeply intoxi- 
cated, there is no agent that can arrest the progress of septicaemia. 
Local disinfection, tonics, and diffusible stimulants administered in- 
ternally, only extend by a few hours a useless fight. By the extreme 
weakness of the subject, the depression of the pulse, the coolness of 
the body, it is easy to see that death is approaching. 

The researches of Chamberland and Roux have shown that it is pos- 
sible to give animals immunity from gangrenous septicaemia, by inject- 
ing into them a sufificient dose "of a completed culture of septic vibrios, 
freed from all the microbes which have proliferated ; that is, by having 
been heated to 110° for 10 minutes." This is a peculiar fact of the 
method of vaccination with soluble substances. The continued action 
•of heat and of antiseptics upon the virulent pus furnished by tritura- 
tion of the muscles of an animal killed by traumatic gangrene, has also 
given to Cornevin vaccines capable of freeing animals from this disease. 
But the duration of the immunity lasts only from fifteen days to a 
month. On this account, these means of giving immunity have not 
been used outside of the laboratory ; they are without practical ap- 
plication 

PUTRID INFECTION — CHRONIC SEPTIC/E.MIA. 

Under the names of putrid infection, chronic septicccniia, and putrid 
intoxication, have been described complications of traumas, and morbid 
conditions which are variable in their characteristics and their progress, 
and remain still doubtful as to their boundaries and nature. Putrid 
intoxication differs from septicaemia and purulent infection ; it is not 
accompanied, like the first, by gangrenous phlegmasia of the peritrau- 
matic zone ; and at the autopsy of those that die with it, metastatic 
abscesses are not found disseminated through the organs, as in the 
second. Complication of large suppurating or gangrenous wounds, it 
seems due especially to the absorption of putrid liquids, and of soluble 
poisons accumulated on the wounds. Colin proved this experimentally. 
In some cases, at the same time that the ptomaines are absorbed, the 
organism may be invaded by microbes of various species and virulency : 
micrococci, staphylococci, and bacteria. Putrid intoxication has a 
march more or less rapid. According to the quantity, the degree of 
nocidily of the toxic products, and the pathogenous activity of the 
micro-organisms which have entered the blood vessels. It may kill in 
a few hours, even in twenty-four hours ; but, ordinarily, it proceeds 
more slowly, and in its principal clinical characteristics differs little 
/rom pyohaemia. 

'Vhe prop/iy/actic traztinent demands the same means as that of puru- 



l84 VETERINARY SURGICAL THERAPEUTICS. 

lent infection. Putrid intoxication has, moreover, become very rare, 
since the era of antisepsis. The extensive purulent centers, the bur- 
rows, and the underminings where pus decomposes and putrefies, should 
be frequently cleansed and irrigated with strong disinfecting solu- 
tions. If the matter secreted by the wound is retained on account of 
its disposition, enlargement of the wound and counter-openings should 
be made with the cautery, and perfect drainage secured. 

As soon as the first indications of putrid intoxication are present 
more care must be given to the traumas, disinfecting irrigations must 
be repeated, nebulizations or baths increased, as the region permits. 
If this is large and extended, its superficial layer should be destroyed 
•with the red-hot iron ; in this way, an obstacle to the absorption of the 
putrid poison will be established. On wounds that suppurate freely,, 
one should use absorbing and antiseptic powders : coal, coal-tar, cresyl>, 
tannin, alone or mixed with iodoform. There should be administered 
internally, tonics and stimulants (sulphate of quinine, carbolic acid,, 
salicylic acid, creolin, alcohol, hay teas). When animals have no 
diarrhoea, according to some veterinarians, it is well to cause one, ia 
order to hasten the elimination of the absorbed toxic matters. 

IX. 
TETANUS. 

This toxi-infectious disease, frequent in horses but rare in the other 
animals, is produced by an anacrobiotic bacillus — the bacillus of Nm>^ 
la'ier — which penetrates into the organism through a solution of con- 
tinuity and gives birth to poisons, whose action upon the nervous 
centers promote tetanic convulsions. 

Up to our time, there were recognized : i, -x traumatic tctaniis,\\^\\v\^^ 
a wound for starting-point ; 2, a spontaneous tetanus, able to appear in 
the absence of a trauma. This old conception of the duality of tetanus 
still has advocates in both medicines. Facts are adduced in its favor 
to the effect that the disease has made its appearance without being 
preceded by a visible lesion of the tegument which would permit the 
passage of the tetanigdnous agents ; but these facts are far from pos- 
sessing the value attached to them. If, indeed, the specific bacillus 
has a marked predilection for deep, anfractuous traumas, with bruised 
borders, ischaemic or gangrenous, there are other ways of entrance which 
jnay remain easily overlooked ; such as the superficial wounds of the 
skin, concealed by the hair, so common in regions in contact with the 
harness or on the extremities ; such as the lesions of the velvety tissue^ 
■which occur in the median lacunas of the frog when this is thrushy, or 
at the commissures of the plantar sole, when there is a loose portion oF 
the wall ; and such as the wounds of all kinds developed on the mucous 



TETANUS, 185 

membranes. And when tetanus appears, the trauma, which has permitted 
the passage of the pathogenous agents, can be entirely cicatrized. For 
these reasons, the numerous observations of " spontaneous tetanus " col- 
lected in the past and those that are reported in our own day cannot be 
seriously opposed to the results of experimental researches, wiiich have 
shown, as irrefutable, the demonstration that tetanus is always traumatic, 
always inoculated and always microbian. Without a wound and without 
the Nicolaier bacillus there is no tetanus. There is no occasion to make 
exceptions for the cases of " tetanus consequent upon a contusion ; " in 
these, either there has been, on the surface of the injured part, destruction 
of the epidermis and introduction in that place of the specific elements 
through a lesion to all appearance closed, but in reality open, or the 
disease has had for its starting-point another solution of continuity, 
cutaneous or mucous, which remained unseen, and the incriminated 
contusion is only an incidental accident, having no relation to the 
tetanic complication except that resulting from their coexistence. 

Enzootics of tetanus have no other cause than the microbe, the trauma, 
and the cold, which promotes its infection. If the Nicolaier bacillus 
is the efficient cause of tetanus, some etiological factors noted by old 
observers remain as adjuvant causes of infection. Powerless to pro- 
duce the disease, they diminish the resistance of the organism, and 
although their mode of action may be obscure they do not the less 
render the soil favorable to the development of specific germs. The 
most efficacious of these occasional causes is damp cold. Numerous 
are the facts collected in veterinary medicine, which show the disastrous 
influence of a damp and cold atmosphere. Those related by military 
surgeons are still more convincing than ours ; sometimes, there have 
been counted by hundreds cases of tetanus in wounded animals exposed 
to the cold of night. In the polyclinic at Vienna, Roll has seldom 
observed isolated cases of traumatic tetanus; he has seen it almost 
always in several animals at a time. We have made the same observation 
at the clinic of Alfort. Months may elapse without a single case being 
brought to the consultation, then a time arrives — almost always after 
a lowering of the temperature — when several are seen in a week, even 
a day, upon animals coming from different localities. One must 
acknowledge, however, that the pathogeny of the disease is not entirely 
elucidated, and that certain conditions of its etiology remain yet unknown. 

The microbe of tetanus has been found in various media. It is 
especially telluric : has for principal abode the superficial layers of the 
ground, where it is found more or less abundant according to countries 
and localities of the same region. It is very common in the northwest 
part of the Paris suburbs ; more than three-quarters of the animals which 
we have treated came from there. It is found in dust, hay, water, 
dung, contents of the intestines, and on the surface of animals' bodies. 



l86 VETERINARY SURGICAL THERAPEUTICS. 

Kitasato has succeeded in isolating it in pure cultures (1889). It 
is polymorphous ; sometimes it has the form of a regular rod (baton- 
net) with blunt ends, or of a delicate rod, short and sporulated 
(batonnet en battant de cloche), or of a spore. Under its bacillar 
form it is very vulnerable, succumbs in a few minutes to the action 
of a heat of 75°, or to the action of most antiseptics; but the spores, 
which are constantly in tetanic matters, enjoy a great vital energy; 
they resist the action of antiseptics and require a temperature of 
105° and 115° to destroy them. 

Vaillard and Vincent have observed that pure cultures of tetanic 
bacilli or spores act only by the toxines that they contain. Not only the 
microbe does not propagate in the tissues where it is deposited, but it 
disappears rapidly, and if, before it is inoculated, it is deprived of the 
toxine to which it is associated, the disease does not develop. It can- 
not produce its worst effects except when acting with some chemical 
substances or some ordinary microbes, especially the pyogenous. 
Inoculated alone, it is rapidly surrounded and destroyed by phagocytes ; 
in company with other micro-organisms, as it occurs with wounds in 
ordinary circumstances, these attract the phagocytes, absorb their 
activity and leave to the tetagenous elements all freedom to act. From 
the wound where it is elaborated, the tetanic toxine spreads and arrives 
in the blood vessels ; it fixes itself in the elements of the centers. The 
nervous cells contain in their protoplasm groups of elements possessing 
a special affinity for tetanic toxine, which they attract with great force; 
once the toxine is fixed on these elements, it remains on them for a 
long time and the lesions of the cells disappear but slowly. They take 
place as long as the wound remains infected, as long as the microbian 
pullulation lasts ; ultimately, it penetrates either in small quantity 
(chronic tetanus) or in doses rapidly fatal (acute-tetanus). Thus are 
explained the persistency and increasing severity of the symptoms. 

The tetanic toxine gives rise to very different effects, according to 
the doses in which it is injected. On this, we have (i) doses that 
kill ; (2) weaker doses, which give rise to more or less serious dis- 
turbances, but are not fatal ; (3) still weaker doses, allowing immuniza- 
tion of animals without producing visible troubles. 

In 1 891 Behring and Kitasato found that the liquids of animals 
made refractory to tetanus by the injection of toxine had obtained 
antitoxic properties. Those liquids (humours) contain an antitoxine 
which may inhibit, render harmless, an enormous proportion of tetanic 
poisons. The injection of a small quantity of serum renders animals 
refractory to tetanus insensible to the action of a large dose of toxine. 
It allows preventive and therapeutical interference. Kitasato having 
found that antitoxine subsists for some time in the organism of the 
horse, recommended already serum to treat the disease in that animal. 



TETANUS. 187 

Antitoxine is possessed of affinity for toxine and draws it away from 
the nervous centers which it particularly prefers ; but it is without 
action upon the toxine already fixed by the nervous cells. Recently 
Wasserman has shown that tetanic poison loses also its toxic proper- 
ties when it is mixed with the crushed cerebral substance of a healthy 
animal. 

All traumatic lesions can be followed by tetanus, whatever their 
extent, depth, or serious nature may be. Observation has shown their 
frequency after wounds of the lower regions of the extremities, of the 
genital organs or of the head. Bruised, irregular wounds, gun-shot 
wounds, those by tearings, crushings, those containing foreign bodies, 
fistulae, pricks, burns, congestions, are peculiarly exposed to it. 

In horses, the traumatic lesions which are most commonly followed 
by tetanus are : Punctured wound of the foot by nails, corns, quitters, 
interferings and wounds made by harness. In most cases it follows 
deep, irregular wounds, involving tendons, bones, articulations and 
nerves, or those containing a foreign body — splinter of wood, projectile, 
metallic fragment, piece of leather or cloth, vegetal parcel or small 
gangrenous stricture. 

Wounds of operation, like accidental traumas, may be complicated 
with tetanus (Jctanus of operation). It has been observed very often 
after castration of males, the introduction of serum, various foot oper- 
ations, less commonly after ovariotomy, the operation for inguinal or for 
umbilical hernia, caudal myotomy, amputations of the tail, removal of 
tumor, firing, the application of a blister, puncture of the caecum. 

Insignificant superficial traumatisms are sufficient for its apposition ; 
sometimes it follows venesection, a simple cutaneous puncture, even 
from an hypodermic injection. 

In females, more commonly in cows, it is observed after parturition 
or abortion {puerperal tetanus). Most of the cases related in bovines 
have been observed in cows after difficult labor, wounds of the vagina, 
uterus, or imperfect delivery. 

In young-borns, principally colts and lambs, tetanus may be a com- 
plication of umbilical phlebitis, especially when it is purulent, gangrenous 
or septic (tetanus of new-borns). In lambs it is not rare to see the 
disease become enzootic. 

Tetanus generally makes its appearance from the third to the fifteenth 
day of the wound, sometimes the second, or even the first ; at others 
more lately, during the third or fourth week, in some cases only when 
the wound is already cicatrized. The difficulty in moving, stiffness of 
the extremities, extension of the head on the neck, are the first troubles 
noticed. Sometimes the contractions are generalized from the start, 
in others they began on the head and neck, on the hindquarters, or the 
yiiuscles in the neighborhood of the wound and gradually extend to 



1 88 VETERINARY SURGICAL TIIERAFEUTICS. 

the trunk or tlie extremities. The nostrils are dilated, lips contracted, 
ears erected and stiff, eyes partly covered by the nictitans, tail more or 
less elevated and stiff. Contraction of the masseters — trismus — is 
more or less marked, prehension of food and mastication are difffcult 
or impossible ; saliva slobbers from the mouth. In most patients the 
muscles of the tongue, pharynx, and larynx are also contracted. 

Ordinarily the neck is elevated and the dorso-lumbar regions slightly 
ciirved downwards {opisthotonos) ; in other cases the vertebral column 
forms a straight horizontal line {orthotonos) ; exceptionally it is curved 
one side or the other (^plcnrosthonos). Contractions are continuous, with 
spasms at certain times. Various causes of excitement produce in- 
creased convulsions. Respiration is difficult, more or less rapid ; 
during the access it increases three or four times the normal number. 
At the outset, circulation is not disturbed, nor in the periods of calm, but 
it increases at the time of the access. Temperature remains normal or 
only a few tenths higher in benignant cases ; in general serious cases 
are characterized by a rise of two or three degrees ; however, they may 
also develop without great elevation of temperature. In the few hours 
preceding death it may rise to 42° C. and above. However, numerous 
causes exist to produce this hyperthermia. 

In acute tetanus the invasion is rapid, the contractions are severe 
and generalized, trismus great, prehension of food and deglutition 
impossible, respiration very difficult and accelerated, pulse quick,, 
paroxysms frequent, temperature elevated. 

Death occurs generally from the second to the fourth day. 

In chronic tetanus, incubation is generally longer, contractions slight, 
trismus weak, disphagia little marked, respiration and circulation not 
much disturbed, paroxysms rare, temperature normal or raised only a 
few tenths. There are cases where this condition remains stationary 
for two or three weeks ; thus by degrees the contractions subside and 
disappear ; in others the disease presents alternate conditions of im- 
provement and of relapse until resolution takes place ; finally, sometimes- 
after a variable length of time, most ordinarily towards the end of the 
first week, the severity of the contraction increases, tetanus becomes 
acute, and death takes place within a few days. Even when the stiff- 
ness seems mild, the disease may last for weeks, and an increase, a 
relapse or complications ought to be always looked for. Pneumonia by 
foreign bodies is possible during the entire disease ; it may occur during 
convalescence, the fourth week, or even the second month. 

The principal symptoms of tetanus are the same in all species. In 
cattle the movements are less rapid than in horses and the contractions 
are less severe. On the contrary, in sheep and dogs the evolution of 
the disease is rapid. Death ordinarily takes place from the sixth to. 
the eighth day. 



TETANUS. 189 

Some authors believe that the mortality is not as high in our day as 
in the past, that acute cases are less common, which would be due to an 
attenuation of the pathogenous agent, or a more rational therapeuty. 
But in horses it seems to have preserved all its severity; only that 
which is observed is the predominance of acute or chronic cases, accord- 
ing to years or periods of times. 

The diagnosis of tetanus offers no difficulties. In some light cases, 
one might, at first sight, mistake it for laminitis ; but the generalized 
stiffness, the tension of the muscles, the attitude of the conical rod and 
of the head, the protruding of the membrana nictitans upon the eye, 
and the tail stiff and extended, are signs permitting the differentiation. 

In all species of animals, the prognosis is most serious. In horses, 
the average mortality is 751^. Out of 30 horses affected with tetanus in 
our wards, from 1888 to 1894, 21 died — a mortality of ^o^fc. Seventeen 
of those affected with acute tetanus died : i the day of its admission, 
4. the second, 4 the third, 3 the fourth, 2 the fifth, i the sixth, 2 the 
eighth. Four others, in which the symptoms were less marked, died : 
I the tenth day, i the thirteenth, i the twentieth, i the twenty-sixth. 
Sudden attack, rapid extension of the contractions to all the muscular 
groups, complete trismus, sweating, great acceleration of respiratioti 
and circulation, and hyperthermia, are manifestations to be dreaded. 
The greater the dyspnoea, the more death is to be feared. A recumbent 
position is a bad sign. Almost all creatures affected with tetanus that 
dropdown in a fit or through exhaustion, die quickly. At all periods of 
ihe disease, but especially in the first, death may be the consequence of 
pneumonia by foreign bodies. After the second septenary, the chances 
»'or recovery are great. 

The prophylaxy of tetanus includes: 1st, the means belonging to 
surgery and hygiene ; 2d, the injection of antitoxic serum. With the 
first, a treble indication is fulfilled : prevent the infection of the wounds 
of operations, disinfect accidental traumas, protect the operated and 
Ihe wounded from the effect of cold. 

Animals operated upon should be protected from tetanus by observ- 
ing the rules of asepsis and antisepsis. The lips of aseptic wounds 
should be held together by sutures, covered with a dressing, or occluded 
with an impermeable substance (collodion); the latter dressing should 
be made at long intervals, as this renewal exposes the wounds to in- 
fection. Wounds of operation soiled during the interference should be 
minutely disinfected ; if they are left open and exposed, they should be 
frequently dressed with antiseptic solutions. .Ml suspected wounds, 
accidental or of operation, soiled by matter ordinarily tetaniferous 
(manure, ground), should be cleansed with a warm antiseptic liquid 
(a strong solution of carbolic acid), carefully washing every part 
and corner of them ; all foreign bodies that they may contain should 



IQO VETERINARY SURGICAL THERAPEUTICS. 

be removed, without disturbing the parts any more than necessary, 
without enlarging the wound, and without exeresies. The bistoury, 
curette, or cautery should be used only in cases where portions of 
tissues are seriously bruised, crushed, and destined to gangrene, or 
are already necrosed. The purification of the traumatic center should 
be completed by a fresh irrigation, by balneation, or by atomization, 
according to the case. Afterwards it should be covered by a protective 
or isolating coat (carbolated or iodoformed vaseline). Finally the 
patients shall be removed from etiological influences which promote 
the action of tetanigenous elements: cold, rain, dampness. Under 
ordinary circumstances, veterinarians cannot realize in their practice 
the conditions of asepsis necessary to prevent tetanus entirely, but it 
is always possible to avoid those tetanic enzootia, which are so com- 
monly reported ; for this, it is sufficient to take stringent measures for 
disinfection, and see that there is perfect asepsis of the hands, instru- 
ments, and objects which come in contact with the wound. 

Injections of antitetanic serum give a temporary immunity lasting at 
least fifteen days, but ordinarily remains from three to five weeks. 
First advocated for man by Vaillard, recommended by Nocard, they are 
absolutely efficacious, providing they are repeated at intervals of ten 
days, as long as tetaniferous or suspect centers are existing. Out of 
more than 2,000 wounded or operated which have been immunized by 
this serum, only one took lockjaw. In the practices where these facts 
have been observed and during the time the serum was used, nearly 
200 cases of tetanus were observed in horses that were not injected 
(Nocard). To wounded or operated large animals, as early as 
possible an injection of 10 Cc. is made under the skin and renewed 
after ten days. When the trauma is extensive, complicated, sup- 
purating for a long time, it may be necessary to make two or three 
other injections at intervals of twelve or fifteen days. With small 
animals, two doses of 5 Cc. are made. As long as the blood contains 
a sufficient quantity of antitoxine, the animals are protected. The 
serum is delivered in vials of 10-20 Cc. ; it keeps its properties for 
several months. Let us remark that preventive serotherapy is practi- 
cally applicable only to animals affected of wounds of operation or by 
accident, which have a' certain gravity. But tetanus occurs quite 
frequently after slight wounds of the extremities, or after lesions which 
are overlooked. 

Among the numerous curative treatments recommended, including 
the most recent, none has shown a great superiority over the others or 
succeeded in establishing itself. There have been recommended as 
surgical means, bleeding, cauterization, free excision of peritraumatic 
tissues, amputation, neurotomy, neurotripsy, polyneurotomy, stretching 
of nerves, even castration for horses; and cases of recovery imve 



TETANUS. 191 

been mentioned to prove the efficacy of all these treatments. But the 
facts reported were only those of benign cases of the slow form of infec- 
tion of chronic tetanus, which, as Teissier says, recovers ivith everything 
and often loithoitt anything. Knowing the nature of the disease and the 
disposition of the tetanigenous agents on the wound, the only means 
which deserve any confidence are cauterization, excision and amputation. 

The favorable results obtained by amputation in the case of mankind 
(Larrey, Berger), and the affirmation of bacteriologists that the Nicolaier 
bacillus remain confined to the vicinity of the wound of inoculation, have 
induced us to try, without very encouraging results, the free incision 
and cauterization of the infected region, with a certain number of ani- 
mals suffering from traumatic tetanus, which have been under our treat- 
ment during the last few years. In a general way, the free removal of 
the tissues of the peritraumatic zone — eradication — has shown itself 
much less advantageous than the simple disinfection and careful 
cleansing of the virulent wound. For man, Verneuil objected to the 
eradication of the toxic center, when it necessitates mutilation ; and 
Chauvel opposed to this treatment the experimental results of A^ail- 
lard, proving that the extirpation of a m.uscle in which a few drops of 
tetanic poison have been injected does not prevent the development 
of the disease. The rapidity of diffusion of the toxic agent goes 
counter, generally speaking, to free ablations. 

As to the medical treatment, it counts agents without number, some 
harmless, others somewhat injurious, all of an indifferent value. Those 
that have been principally used are opium and morphine, belladonna and 
atropine, hyoscyamus, stramonium, alcohol, ether, chloroform, chloral, 
curare, Calaborbean, eserine, jaborandi, and pilocarpine, spirits of tur- 
pentine, with oil, iodine, salicylic acid, and quinine in intratrachial in- 
jections, bromide and iodide of potassium, and inhalations of oxygen, 
bichloride of mercury and phenic acid in intravenous injections, 
bromhydrate of quinine and antipyrine in intratrachial injections, and 
finally the antitetanic serum in cutaneous or intravenous injections. 
All those agents have given more failures than successes. None can 
overcome the tetanic spasm. Medicamental substances, however, 
which reduce the hyperexcitability of the spinal cord have a beneficial 
action and attest towards recovery : two especially, chloral and mor- 
phine, are advantageous and constitute the medicaments to be preferred. 
Morphine has the disadvantage of provoking phenomena of excitement 
in the horse; it should be used only in small repeated doses ; in large 
or even medium doses, it has always shown itself to us more injurious 
than beneficial.* Chloral can be administered through the rectum by 
intravenous injections. If it is introduced into the digestive canal it 

* C. D. Norris claims to have had good results by subcutaneous injections of sul- 
phate of eserinic and dilute hydrocyanic acid. (Am. Vet. Rev. Vol. 15, p. 3S6.) (T.) 



192 VETERINARY SURGICAL THERAPEUTICS. 

must be well diluted. We i^refer giving it in lavements, 100 to 150 
grammes a day and in solution of i in 50. The intravenous injections 
(Poitevin, Poret, Jacobin) must be considered as a last resource ; 
20 or 25 grammes of chloral are injected in the jugular, according to 
patients ; often a temporary relief is obtained ; the injection is repeated 
when the contractions return. 

Let us present a curative treatment, according to the data already 
established. 

Whatever may be the form of tetanus, one must, first of all, look for 
the wound, which has served as means of entrance to the bacilli. 
Cleanse it well with hot water, evacuate the recesses of the wound, 
disinfect it with care with strong antiseptic solutions (sublimate in acid 
solution, phenol, tincture of iodine or chloride of zinc), remove all 
foreign bodies, if there are any; in some cases enlarge the wound, 
excise the grangrenous or necrotic parts as as well the fungous granula- 
tions. After another antiseptic irrigation, the wound should be dusted 
with iodoform and covered with vaseline or wadding. If there are 
several wounds all should be treated with the same care. Some fist- 
ulous or anfractuous wounds require the ablation of a wide and thick 
layer of tissues to remove the toxi-infectuous center. 

The antitetanic serum has not given the results that were first ex- 
pected. Excellent to grant immunity, it is ordinarily powerless as soon, 
as the poison has reached the nervous system. However, it may avert 
the increase of the manifestations by presenting new quantities of toxine 
reaching those centers. 

The wounded should be put in a place where the temperature will 
be moderate and regular, and protected from exciting causes, noise, or 
strong light; if possible, this place should be isolated, spacious, dark, 
with an abundant bedding of supple and short straw, to permit the 
motions of the animal without his legs being entangled, as they might 
be were the straw long. Cut straw may irritate by pricking the skin o£ 
the extremities. A box stall is always to be preferred, with the window 
covered with a thick blanket, to make it as dark as possible. To be 
alone is sometimes a cause of uneasiness to horses ; they get impatient 
and restless. Instead of placing them alone, it is better to have them 
standing in their own stalls, giving them quiet neighbors. Contagion 
might not be impossible for these, if they had wounds on them on 
which tetanic pus should be accidentally deposited; but direct con- 
tagion is an exception, and can be prevented by simple means. 

The opening and closing of doors, surrounding noises, strong light, 
or touching with the hand, may promote exacerbations ; frequent visits 
should be avoided ; changes, examinations, and explorations are useless ; 
no one except those who care for the patient should approach it. Rest, 
quiet, darkness, soothe muscular hyperexcitability ; the attacks occur 



TETANUS. 193 

further apart, the contractions diminish, the respiration is easier. 
During summer one should see that the animal does not suffer from 
excessive heat ; in winter, he should be sufficiently covered to keep the 
skin slightly moist ; if perspiration is too abundant, blankets must be 
changed. In severe cases, where there is danger of falling, slings are 
advantageous. 

The patient should be sustained with substantial food. It should 
receive liquid food especially (mashes, farinaceous drinks, hay tea, 
milk, soup), grass and cool water at will. If trismus and dysphagy do 
not allow the swallowing of these substances, nutritive rectal injections 
should be given four or five times a day. It is sometimes necessary 
either to empty the rectum, or to help micturition, by pressing upon 
the bladder through the rectum, or by the introduction of the catheter. 
Besides this, injections of serum shall always be indicated to destroy 
the toxine which still penetrates in the blood. As medications, 
one should employ agents which can be used with food, drinks, 
or lavements, or in hypodermic injections (purgatives, alkalines, 
antiseptics, chlorhydric acid, iodine, morphine, chloral). The admin- 
istration of drenches is sometimes impossible on account of the 
trismus ; for us, these are always forbidden on account of the excite- 
ment they give rise to, the danger of their passing in wrong directions, 
and the severe complications following. One may, by giving daily 
100 or 200 grammes of sulphate of soda in drinks, prevent constipation, 
and 2 to 6 grammes of aqueous extract of belladonna, or opium, will 
quiet the nervous irritation (Trasbot). In acute cases the hyperexcit- 
ability should be controlled with chloral, administered by injections 
through the rectum, and morphine in small doses by hypodermic in- 
jections. 
13 



CHAPTER IV. 
GRANULATIONS— CICATRICES. 

In the cicatrization of traumas with loss of substance, as soon as the 
granulations have reached the level of the skin, their growth generally 
ceases; they become even; their structure is more dense ; connective 
structure develops in them ; blood vessels are obliterated ; cellular elements 
disappear by regression ; the purulent secretion diminishes more and more ; 
and at the periphery of the wound, at the limit of the cutaneous borders 
and of the newly formed tissue, there appears a slightly projecting circle, 
a kind of reddish band, which progresses slowly toward the center of the 
cicatrix, followed at a short distance by a very thin band of darker color. 
This new layer, which ordinarily spreads evenly on the innodular tissue 
from the periphery to the center of the solution of continuity, is the 
regenerated epidermis. Sometimes in large wounds, when small pieces 
of skin with the Malpighian layers have been preserved, the new forma- 
tion of the epidermis takes place at several points. At the same time 
that the cicatrization advances, the tumefaction and the morbid sensibility 
gradually diminish and disappear. 

But the repairing process does not always follow this normal progress. 
Often, especially with extensive lesions, the cicatrization is disturbed, the 
new tissue assumes a peculiar aspect or character, due to various pathologi- 
cal conditions of the granulations. 

Sometimes, because of some disease or some general cause interfering, 
the granulation relaxes and stops before the wound is entirely filled. It 
must be stimulated by exciting preparations, strong antiseptic solutions or 
superficial cauterization with the nitrate of silver. 

More commonly, the granulations rise quite high above the cutaneous 
layer, and are exuberant. Among horses and cattle, it is quite common 
to observe, especially on wounds of the extremities, cicatrices more or 
less protruding, which in their earlier stages can easily be controlled by the 
use of drying powders, styptic applications, pressure, or dressings with 
astringent preparations (tannin, white lotion). 

Fungous granulations protruding much above the level of the skin, 
and sometimes covering its edges, assume an aspect resembling that of 
194 



GRANULATIONS— CICATRICES. I95 

mushrooms. Ordinarily soft, friable and bleeding, they secrete in various 
quantities a thin and serous pus. They are almost always due to local 
causes : sometimes the fungosities conceal or contain foreign bodies 
(granular wounds) ; at others the cutaneous edges are indurated, callous, 
or loosened for some distance ; or again the edges are irritating to the 
granulations by their constant motion. In some circumstances, the cause 
of the anomaly cannot be made out. When the cause is established, it 
is simple to obtain the cicatrization by extending to it the treatment 
required by that cause ; but it is necessary sometimes to excise the granu- 
lations or to destroy them, either with caustics (alum, nitrate of silver) or 
with the actual cautery. 

Erethistic granulations are the seat of a well-marked morbid sensibility : 
the slightest touch upon it gives rise to sharp pain, combined sometimes 
with an alteration of the nervous fibers of the edges or of the bottom of 
the wound. Ordinarily, the peritraumatic zone is much inflamed. The 
anomaly may be due to the presence of foreign bodies ; and their re- 
moval, the application of warm compresses or balneations, analgesical 
vaseline, iodoform or cauterizations slight and repeated are ordinarily 
successful. In some cases it is necessary to cauterize the entire granular 
layer, or the most painful parts of it. 

One observes sometimes, in cicatrizing wounds of all animals, the in- 
fectious complication described under the name of diphtheria of granula- 
tions. It is a mild form of hospital gangrene. From one day to the 
next, the surface of the wound is covered with a diphtheritic yellowish 
gray layer several millimeters thick. Under this false membrane the 
granulations are softish, dark red in some places and yellowish or grayish 
in others. When this complication occurs on recent wounds not entirely 
protected by a granulating layer, it always is complicated with a serious 
lymphangitis of rapid development. Sometimes the granulations disinte- 
grate and ulcerate, and a putrid detritus collects on the wound. We have 
observed this affection in horses and in dogs. Hoffmann has seen it in 
the horse ; Moller in dogs and birds ; others have mentioned seeing it in 
cattle. Cultures, on gelatine and gelose, of the products taken from the 
surface of the granulations have given us colonies of streptococci. 

This diphtheritic condition of the granulations is treated by a minute 
disinfection of the wound with warm solutions of corrosive sublimate, car- 
bolic acid or chloride of zinc. When it takes place upon an extremity, 
balneation in an antiseptic solution at 45-50° and iodoform dressing are 
very advantageous, especially if there is complication of lymphangitis. 
If the trouble resists, the surface of the granulations must be destroyed 
with the cautery or removed with the curette, and the wound must be 
dressed with iodoform. 



196 



VETERINARY SURGICAL THERAPEUTICS. 



The tissue of new formation which repairs solutions of continuity and 

losses of substance is at first, we have said, exclusively formed of embryonal 

elements and blood vessels ; as its organization becomes more complete it 

sustains a retraction which gradually increases : the 

hair, follicles, sudoriferous and sebaceous glands are 

not reconstructed. 

Cicatrices whose development is complete are glab- 
rous, dry, ordinarily indolent, smooth or slightly rough, 
marked with ridges and fissures little developed, some- 
times with bands and grooves running in various di- 
rections. With some there remains, even for a long 
time, a great sensibility. When they are situated in 
regions where there are frequent motions (those upon 
which the harness is) or on the tissues of the foot, 
they interfere with work and even prevent it, or impose 
a more or less active interference, such as the removal 
of the innodular part, the thinning of the new hoof, 
or neurotomy. When the pain seems to be due to 
the adherence of the cicatrix to the tissues underneath, 
this must be divided subcutaneously and a sound ad- 
herence prevented by passive movements applied 
on the cicatricial plate. This operation is, however, 
seldom successful. 

Projecting cicatrices, old and fibrous — the cicat- 
ncial cheloids — generally do not yield to the means for 
recent wounds which we have spoken of. Formed by 
dense connective fasciculi, elastic fibers, blood ves- 
sels and an epidermic covering, they are at times some- 
what regular, at others mammillated, multilobular, always fibrous, whitish, 
glabrous, hard under the scalpel, or are covered with stratified epi- 
dermic layers or horny growths. Among cattle, we have seen some of 
those horny plates in various regions, and among horses, on the lower 
parts of the legs. According to their dimensions and the length of time 
they have existed, they are treated by cauterization or excision. 

Recent sessile cheloids may disappear by long and continued methodic 
pressure or by repeated scarifications and mercurial applications. When 
these fail, ablation is the only treatment offering any chance of success. 
This is also the best way to get rid of enormous projecting cheloids, more 
or less pedonculated. Among animals, relapses are rare outside cases of 
cicatrices resulting from the extirpation of tumors. Primitive neoplasms 
of innodular plates are also exceptional. 

Some very extensive wounds, and all those accompanied with loss of 




Fig. 46. — Horny 
Cheloid of the 
Left Foreleg. 



GRANULATIONS — CICATRICES. I97 

substance, which occupy regions in the neighborhood of natural openings, 
may be followed by deformities and accidents more or less serious. 
The large cutaneous cicatrices of the lower segments of the extremities 
bring sometimes, by their retraction, permanent deviations of the bony 
levers ; those situated near articulations interfere with movements ; those 
of the coronary band deform the hoof, give rise to quarter-cracks and 
false quarters ; others, developed in natural canals or in proximity with 
their openings, promote ectrojiion, contraction of the sesophagus, rectum, 
anus or urethra. 

Among the deformities and the accidents due to cicatrices, there are 
some which can be prevented by more judicious selection of the therapeutic 
means applied to the original lesion, and by a close watching of the 
phenomena of cicatrization. The results obtained by Romary and Smith 
show that it is possible to prevent some deformities in animals \)y cutaneous 
grafting, which gives such happy results to man (Reverdin, Gosselin, Duplay, 
Oilier, Thiersch). 

Their curative treatment demands methods which vary according to 
cases : section of cicatricial bands, forced dilatation of obstructed orifices 
and canals, special operations, and the administration of iodide of potas- 
sium — a medication preferred to overcome sclerous processes. 

In certain regions where glabrous cicatrices are unsightly disfigure- 
ments on a horse, they can be removed by excising a long elliptical 
cutaneous flap, with the cicatrix in the center, and sewing, with silk or 
silkworm-gut suture, the edges of the new wound which have been made 
loose from the tissues underneath. To succeed in obtaining union by first 
intention in such an operation it is necessary to take all the necessary pre- 
cautions for perfect asepsis. 

This treatment can be advantageously applied to valuable horses having 
broken knees if their modes of standing are normal and their extremities 
solid. 

Treatment by operation upon broken knees goes back to 1829. Cherry^ 
made the attempt of removing a carpal cicatrix by excision of a vertical, 
elliptical cutaneous flap, with the cicatrix in its center. In order to assist 
the sliding of the skin, he also made on each edge of the wound, at some 
distance from it, longitudinal incisions parallel to the borders of the wound. 
This was an application, to the therapeutics of broken knees, of the old 
method of autoplasty, or Ce/su's method, used for the treatment of various 
affections of mankind. Cherry was partly successful with a donkey, but 
was " disappointed " in operating on a horse. Other attempts made by 

1 Cherry, on Broken Knees : The Farrier and Naturalist, 1S29, pages 38, 358, 
372. 



198 



VETERINARY SURGICAL THERAPEUTICS. 



VLirious parties were not much more fortunate. Before antisepsis was 
known they could not succeed. In 18S9, W. Hunting and Duguid' 
made new trials. Like Cherry, they removed, with the cicatrix, a long 
elliptical cutaneous band, the long axis of which was parallel to the ex- 
tremity ; a pin twisted suture brought the edges of the wound together. 
They did not obtain a complete adhesive union ; still, on one subject, there 
remained only a very slight cicatrix. Hunting advises operating only 
upon old cicatrices, and insists upon the necessity of immobilizing the leg 
if one would have com.plete success. 





Fig. 47. — Autoplasty of the Broken Knee. (From Cherr}-, reproduced by \V. 
Hunting.) 

Delcambre and Vinsot " have reached this result by maintaining the 
most careful asepsis, and by immobilizing the leg in a plaster dressing. 
This is their method : 

The animal is thrown on the side opposite the leg to be operated upon ; 
this is carried in extension and strongly fixed. The anterior face of the 
knee is shaved, and this region and its surroundings, having been thoroughly 
disinfected, are wrapped in a cloth made aseptic l)y immersion in boiling 
water. 

With scissors, an opening (fenestra), elongated in the direction of the 
leg, is made through this wrapper, on a level with the cicatrix. Two slightly 
curved incisions, meeting at a very acute angle at their extremities, define 



' IV. Hiintmg, the Veterinary Journal, 1SS9, p. 474. 

" Delcapibre and Vinsot, Bullet, de la Soc. Cent, de Med. Vet, 1894, p. 515. 



GRANULATIONS— CICATRICES. I99 

the piece of skin to be detached, which is to be left as narrow as possible. 
It is dissected away from the hardened tissue underneath, the synovial 
membranes being carefully avoided. Hemorrhage is arrested by force- 
pressure, the wound is dried with aseptic plugs, and the edges are sutured 
with silkworm gut, the stitches being one centimeter apart. If the loss of 
substance is too great, before sewing, the edges of the wound are made 
loose underneath for an extent sufficient to permit their perfect adaptation. 

The suture and the shaved surface are all powdered with iodoform and 
covered with iodoform gauze ; absorbing wadding is wrapped round the 
knee, canon, and lower part of the forearm, and the whole secured by a 
large band of muslin. To insure immobilization, a plaster dressing is placed 
over the muslin, made of similar stuff. 

On the tenth day the dressing is taken ofif. If the operation has been 
performed aseptically, union by first intention has taken place. Another 
similar dressing is applied, less the plaster, which has become unnecessary. 
This is removed after eight days. The cicatrix is then sufficiently solid to 
require no more protection or care. The animal can resume light wcrk. 
A narrow line, subsequently covered by new hair, is the only mark left when 
the operation is well performed. 



CHAPTER V. 
SECTION I. 
MYCOSIS. 

I, 

ACTINOMYCOSIS. 

Comparatively common in cattle, observed also in horses, swine, sheep, 
dogs (Vachetta, Frohner), and elephants (Burke), actinomycosis is a para- 
sitic disease, produced by a fungus — the actinoinyces of Harz. It exists 
extensively in Germany, the south of Russia, Italy, Denmark, England, and 
the United States, and has been observed in some parts of France. It is 
exceptional in the suburbs of Paris. In ten years, we have seen but one 
case among the cattle brought to the clinics of Alfort. 

Actinomycosic tumors are primitive or secondary. The former exists 
on the parts where the germs have penetrated : on the skin, the mucous 
membranes, or the tissues that cover them. It has been observed in the 
skin and the subcutaneous connective tissue of a number of regions. 
Jensen has seen a pig which had, on the anterior face of the knees, two 
actinomycomas, weighing, one, two, the other four kilos and a half. In 
countries where the disease is enzootic, many traumas, the wounds of 
castration principally, become actinomycosic centers. Often their seat is 
on the head, where they invade the maxillaries. Such were those which, 
in 1826, Leblanc described as " osfeosarco?na," and which others called 
''spina vcntosay Such are those spoken of in the observations reported 
by d'Arboval, Clare, Dick, Daws, Dupont, Warnell, Delwart, Williams, 
and many others. While the tongue, the buccal and pharyngeal walls, 
the retro-pharyngeal glands and the parotid are often affected, the intes- 
tines seldom are. Rare also are the primitive lesions of the nasal cavities, 
larynx, lungs, of the udder or bones of the legs. In horses, cases of ac- 
tinomycosis have been observed in bones, the tongue, subglossal glands 
and spermatic cord. 

Primitive centers give rise to secondary lesions in their neighborhood 
or at a distance from them, and when the disease becomes generalized 



ACTIXOMVCOSIS. 



201 




Fig. 48. Actinom5'Cosis of the Lower Maxillary. 



they may heal, as in tuberculosis, without leaving apparent marks. Ac- 
tinomycites ordinarily spread slowly, little by little, through the blood ves- 
sels, and apparently most 
often through the veins. 
All tissues and all organs 
may be attacked, and if, 
ordinarily, secondary tum- 
ors develop in the lungs, 
they are also observed in 
the liver, kidneys, spleen, 
serous membranes, lympha- 
tic glands, and even the 
encephalon. 

Locally, the disease pro- 
gresses both by continuity 
and contiguity of tissues. 
For instance, pulmonary 
actinomycosis not only 
generalizes often in both 
lungs, but it extends from 
the visceral layer to the 
parietal layer of the pleura, 
obliterates the pleural cavi- 
ty, and reaches the thoracic 
walls, where its clinical 
signs can be easily recogn- 
ized. 

The ways by which the 
actinomycites are intro- 
duced are numerous. 
Generally, they penetrate 
through tegumentary so- 
lutions of continuity, 
wounds of the skin, or 
mucous membranes, but 
especially by the wounds 
of the mouth and of the 
pharyn.t ; at times they 
enter through natural pass- 
ages, glandular canals and ^'S- 49- Actinomycosis of the Tongue, 
orifices of the teats ; it is the exception for the disease to start in the 
intestines or the lungs. Pulmonary infection may take place from the 
dust blowing out of forage that contains actinomycites, 




202 VETERINARY SURGICAL THERAPEUTICS. 

It is known that these germs have especially for habitat, plants, more 
particularly the gramineous, and among them barley and wheat. They are 
abundant in damp countries and during rainy seasons. As all fungi, they 
like darkness, heat, and dampness. They have been found in the glumes 
of wheat fixed in the tonsils, cheeks, and tongues of cattle (Johne, Plana). 
It is by eating contaminated seeds or forage that herbivorous animals are 
ordinarily inoculated. Thus it is also that the fungi may enter by way of a 
cutaneous wound, when animals are lying on beds which contain them, or 
rub themselves against soiled substances, trees or posts covered with them. 

That they are caused by plants cannot be doubted, since the belief is 
based upon numerous facts. This explains well the frequency of the 
disease among herbivorous animals and its extreme rarity among other 
species. 

All forms of actinomycosis, and especially those of buccal localizations, 
are observed less frequently at the time of the year when animals are kept 
in the pasture, than in winter when they are fed on dry food which 
wounds the buccal mucous membrane and makes a way for the entrance of 
the actinomycites (Eckert, Claus, Klepzoff). At the abattoir of Moscow, 
towards the end of 1893, the cases of buccal actinomycosis were twenty 
times more numerous than during the summer and fall of the preceding 
year (Klepzoff). 

While offering noticeable differences, the statistics made by veterinarians 
of the countries where the disease prevails, show that actinomycosic lesions 
of the head, neck and skin are much the more common. Statistics of 
Cbus give the following figures : Actinomycosis of the maxillaries (especi- 
ally the lower ones), 5 i per cent. ; of the tongue, 29 per cent. ; of the 
pharynx and peripharyngeal structures, 7 per cent. ; of the larynx and 
trachea, 6 per cent. ; of the thoracic and abdominal organs and other regions, 
7 per cent. In those of Imminger, while actinomycosis of the tongue is men- 
tioned only at 4-8 per cent., the localizations in other parts of the head and 
neck amount to 85-90 per cent. In 15 diseased cattle 14 had the 
maxillaries affected. In 541 observations gathered by Mary are found : 
271 lesions of the skin; 177 of the sub-maxillary glands ; 117 of the 
bones of the head ; 5 i of the retro-pharyngeal glands ; 38 of the superior 
cervical glands; 29 of the; lungs; 5 of the inferior cervical glands; 5 of 
the tongue ; 4 of the pharynx ; 4 of the bronchial glands ; 4 of the dia- 
phragm ; 7 of the other organs (Friedberger and Frohner). At the abattoir 
of Petersburg, where Ignatjew counts actinomycosis on about 10 per cent, 
of the cattle of Southern Russia, localizations on the lips and lower maxil- 
lary are the most frequent. 

Most external actinomycoses exhibit the following aspects : Hard tumors, 
and an immediate inflammatory indurations and true neoplasms, hQllgwedl 



ACTIXOMVCOSTS. 



20' 



with numerous fistulos from which escapes a pus more or less loaded vvith 
very small retldish-yellow masses resembling small gravel. Some forms of 
recent actinomycosis are neither ulcerated nor fistulous ; they resemble sar- 
coma yery closely and their center is hollowed by one or more purulent 
centers whose contents hold the actinomycetes in suspension. Others 
already large and protruding exter- 
nally, are open deep down on a 
mucous membrane. In some cases 
secondary tumors are found irreg- 
ularly distributed round the primi- 
tive tumor or arranged in chaplet 
form. Under the microscope the 
actinoniycetic mass appears made 



of diverging, regular or undulous C^^^rz 



filaments, sometimes ramified and 
ending with pyramidal enlarge- 
ments (conidia). This appear- 
ance in " umbrella " shape is suf- 
ficiently characteristic to permit the 
diagnosis. 

The treatment of actinomycosic 
tumors includes the numerous means 




Fig. 50 — Actinomycoses boris magnified 
900. 



used against chronic inflammatory productions and against true neoplasms. 
Leblanc employed mercurial ointment and points cauterization ; Cruzel, 
irritating frictions (spirits of turpentine and blistering liniments) ; Harms, 
applications of an ointment of equal parts of arsenious acid and lard. To 
dry the fistulse, injections of sulphate of copper, carbolic acid, 10 per cent. 
(Rosenbach), and cauterization are recommended. These means have 
very generally failed. Extirpation of the tumor and the use of the curette 
have given better results in the case of external lesions. Where these 
" osteosarcomata " were treated early they gave way to surgical interference, 
but when the maxillary was invaded in a great part of its thickness, a 
secondary fracture was always to be feared. For this reason, in serious 
cases, it was better to have the animal destroyed. Some success has been 
attained in the case of man by the use of tubercuhn (Billroth) and by electro- 
chemical treatment (Darier, Gautier). 

Numerous clinical facts obtained during the last few years prove that 
iodide of potassium is a true specific for the disease. Already in 1859 
Dupont had reported several recoveries of " parotid indurations " by a com- 
plicated treatment into which iodide of potassium entered. But it was 
Thomassen (18S5) who demonstrated the remarkable therapeutic value 
q£ this compound. Used first against "wooden, tongue," which, was 



204 VETERINARY SURGICAL THERAPEUTICS. 

cured in from two to four weeks, it was tried against osteosarcomata and 
some other localizations of the disease. The results were favorable in 
almost all cases, and healing often rapid (Furthmeyer, Bass, Nocard, God- 
bille, Salmon, Engel Iterson, Soucail). Thomassen administered daijy one 
dose of 6 grams of the iodide in half a bottle of water ; as soon as 
signs of iodism — epidermic pellicles, flowing of tears, coryza, diarrhoea — 
appeared, he lowered the dose to 4 or 5 grams. 

At the onset of the disease, large doses of iodide (10 to 15 grams 
daily) must be given. Often, as remarks Nocard, the advantageous effects 
of the tieatment are not manifest until the signs of iodism are present. 
Although local treatment is not indispensable, it is useful in the greater 
number of cases of external actinomycosis. For " wooden tongue," Furth- 
meyer advises painting the diseased organ with tincture of iodine; 
others inject the same liquid into the fistulge of the osteosarcoma. In 
parotid actinomycosis, the ointment of iodide of potassium has proved 
advantageous. 

In general, with the iodide and the local treatment, improvement is soon 
manifest ; the swelling diminishes, fistulas dry up, and after a few week, 
recovery is complete. There are some localizations, however, that remain 
obstinate (Salmon). With man, Poncet failed in a case of pulmonary 
actinomycosis. Several other surgeons have also reported failures. 

II. 
BOTRYOMYCOSIS. 

Among the tumors of horses classed among fibromse, there aresome 
that are of a parasitic nature, determined by a fungus that Rivolta has 
named discomyces equi, that Rabe called micrococcus botriogetiics, and 
Johne micrococcus ascoforvians. This parasite — the botryomycis or botryo- 
t?iycete — is the agent of a portion of the _//^;//<:7^///(:'x, which give rise to com- 
plications in the castration of solipeds ; but its field of action is not limited 
to the spermatic cord : it has been seen in numerous indurations produced 
by the harness, in many of the tumors of the skin and of the connective 
tissue, in sub-maxillary adenitis and other lesions developed in many other 
organs. Bollinger, Steiner, and Thomassen have found it in sclerotic 
and purulent parts of the Itmgs ; Sand and Moller, in indurations of the 
udder ; Jensen, in a tumor of the fetlock ; Kitt, in one of the tail and in 
a bony lesion ; Rabe, in a tumor of the back. We have frequently seen it 
in various regions, in chronic inflammatory neoformations of the skin and 
subcutaneous tissues, sometimes also in old fistute, w-ithout strong indura- 
tions of the surrounding tissues. It is extremely rare in cattle (Csokor) and 
swine (Wilbrandt) and is not reported as found in other species, 



I'.OTRVOMVCOSIS;. 



?05 




In general, botryomycosic tumors grow gradually, and little by little in- 
vade the adjoining 
tissues. Like ordi- 
nary fibrom?e, they 
leave intact the sur- 
rounding lymphatic 
vessels ; by excep- 
tion they extend to 
some distance by 
continuity and by 
contiguity of tissues ; 
and thus they may 
each serous cavities 
and certain viscera, 
especially the lungs. 

In the horse, most 
of the fibrous growths 
hollowed by sup- 
Fig- 5^^ — Botryomycosis of the shoulder and chest purating fistute are 
(from a photograph). related to botry- 

omycosis ; the pus that escaped from them contains very small granula- 
tions, grayish in color and formed by 
the botryomycetes. To insure the di- 
agnosis, one can color with picro— 
carmine a drop of the pus and ex- 
amine it under a microscope of low 
power, when the parasitic masses, 
colored in yellow, will appear in vary- 
ing number, ordinarily under the 
form of " blackberries," masses or 
clusters more or less voluminous, and 
formed of micrococci associated in 
zooglocia, sometimes in large disks 
lightly granular. 

Until lately, the treatment of bot- 
ryomycomas has been exclusively 
surgical. First they enlarged the fistu- 
lous tract, used antiseptic or escharotic 
injections and actual cauterization. 
As these processes generally failed, 
it was necessary to have recourse to 




ris. 



52 — Botryomycosis of the tail 
(from a photograph). 



ablation of the tumor. When it is of small dimensions, the operation 



206 VETERINARY SURGICAE TIIFRArEUTICS. 

is easy, and is performed like that of benignant neoplasms ; if the 
whole of the invaded tissues are removed, cicatrization takes place 
regularly. Some months ago we removed from the shoulder an old 
enormous mycofibroma, having many fistulce which poured out a quan- 
tity of yellowish-white pus somewhat consistent and granular ; the 
wound was closed in twenty days without any later interference be- 
ing necessary. For the botryomycoma of the tail, the amputation 
must be made above the growth. The removal of the " champignon " 



,.^m^ 



-m 




') 



^^g- 53 — Discomyces equi. (Gr. i6o P.) 

is an Operation of daily practice. (See Testicle and Cord.) But sometimes 
in cases of long standing the tumor cannot be operated upon, since the 
mycosic j^hlegmasia propagated along the testicular cord has reached, or 
gone beyond, the superior inguinal canal. 

Thomassen, in several serious cases, has used with success iodide of 
potassium internally and tincture of iodine locally externally. The iodide 
was given in lo or 15 gram doses a day, with two or three injections of 
the tincture into the fistulous tracts. This treatment may be useful, but 
it is slow in its action and not positive in its results. If it has given us 
partly successful cases, wei have often used it for "champignon" and 
cutaneous mycofibromce without the slightest benefit.' 

We will resume the treatment of botryomycosis as follows : In all cases 
where the tumor justifies surgical interference, remove it at once ; if the 
operation is impracticable or dangerous, try, for a few weeks, iodide of 

' We have had several occasions to use this treatment on horses brought to the 
clinics of the American Veterinary College, and have generally obtained ex- 
cellent results with it. ^Translator.) 



iBACTERIAN ANTHRAX. 26/ 

potassium internally and the injections of iodine externally. After this 
length of time, if no improvement is manifest, there is but little hope 
of the efficacy of the iodine treatment. 

SECTION 11. 
VIRULENT DISEASES. 

I. 

BACTERIAN ANTHRAX. 

Like septicsemla, fiarter/a// or sr/zi/fomafic anthrax is an infectious com- 
plication of wounds. Cattle and sheep are the only animals affected. 
It is of especially frequent occurrence among cattle, but animals less 
than six months or more than four years old rarely have it. 

The specific bacterium — bacterium Chairrai — invades the organism 
through wounds of the skin and mucous membranes, and has to be intro- 
duced deeply into the subcutaneous connective tissue. Intrad.ermic in- 
oculations and superficial pricks remain almost always sterile. 

The disease develops ordinarily through the wounds that animals receive 
in infected pastures. Wounds of the lower regions of the extremities ex- 
pose them to it particularly. The buccal and pharyngeal membranes 
are also roads of entrance favorable for infectious elements : there are 
frequent accidental wounds in them from the fodder, and the growth of 
the adult teeth keeps up for a long time in the mouth lesions by which the 
bacilli may enter. 

After an incubative period of from one to fi\'e days — on the average forty- 
eight hours — the characteristic phenomena of the infection appear, namely, 
one or several subcutaneous, crepitating tumors and specific adenopathies 
in their neighborhood. These tumors are ordinarily located on the chest, 
axilla, shoulder, croup, thigh or groin. Although they are only more or 
less painful and of small size at first, they spread very rapidly and may in a 
few hours assume considerable dimensions ; by palpation they give the 
sensation of crepitation ; by percussion, a tympanitic sound ; soon their 
center becomes insensible and the skin is cold and gangrenous. Puncture 
gives escape to a reddish fluid filled with gases. The prophylactic measures 
are to protect the animals from the infection by avoiding exposure or by 
rendering them unsusceptible through vaccination (Arloing, Cornevin 
and Thomas). 

The malignant nature of the disease and the rapidity of its progress 
generally render all interference useless. " When recovery occurs, it 
seems to take place spontaneously ; and when it is in connection with the 



2o8 VETERINARY SURGTCAt. TIIERArEUTICS. 

use of a more or less appropriate treatment, the part played b)^ this 
treatment is very problematical and not well defined " (Galtier). 

The local therapeutic means are the penetrating point, firing and the 
injection of tincture of iodine and carbolic acid or corrosive sublimate 
water in the tumor. Stimulants (alcohol, acetate of ammonia) and anti- 
septics (carbolic acid, cresyl) form the basis of the internal treatment. 
The proportion of recoveries does not go over 3 to 5 per cent. 

The disease is the subject of special sanitary measures. 

n. 

BACTERIDIAN ANTHRAX. 

Frequent in horses, cattle and sheep, hacteridian anthrax is rare in 
pigs and carnivorous animals. Its specific agent — bacteridia — may enter 
the organism through the digestive or respiratory mucous membranes and 
the skin. Infection by the digestive mucous membrane is the most com- 
mon ; it is produced by the spores of anthrax taken in with the food and 
drink. Inoculation ordinarily takes place in infected pastures {champs 
maiidits), or when animals eat the feed grown on them, and it is most 
commonly carried through wounds of the buccal or pharyngeal mucous 
membranes (Pasteur, Toussaint). Infection through the lungs (anthrax by 
inhalation) is extremely rare. Infection by the skin, possible in all ani- 
mals, is more common among horses and sheep than among the others. 
It gives rise to the forms known as luali^^nant piisiiile, or external anthrax, 
he only ones which are interesting to our subject. Any solution of con- 
tinuity of the skin or of the tegument of natural openings may be its 
starting point. It has sometimes been produced by operations with instru- 
ments which had served for post-mortem examination of anthrax cadavers; 
by the bite of dogs that had just eaten carbunculous meat, and by the 
stings of insects. Davaine, Bollinger and Zeilinger have given anthrax to 
animals by inoculating the matter obtained by the crushing of flies taken 
on anthrax cadavers. If left upon a wound, even the most superficial, the 
spores develop and are transformed into bacilli, which multiply, invade the 
surrounding tissues, promote in them a violent inflammation and a warm 
and painful tumor, whose dimensions increase rapidly, so that it soon 
presents a mortified center and an oedematous periphery. The bacteridies 
invade the lymphatics, the glands of which become inflamed and present 
constant lesions : hypersemia, tumefaction, hemorrhages and oedematous 
infiltration (Colin). Being erobica, they can penetrate directly into the 
blood, where their multiplication is especiafly active. 

Their /r<?^/y'/a;v« imposes two principal conditions ; Keep the animals 



FARCY. 209 

away from infected pastures ; confer on them immunity from the disease 
by Pasteurian vaccination. 

To destroy the anthrax virus deposited in the wound of inoculation, 
and to prevent its absorption by the circulatory and lymphatic channels, 
are the basis of an efficacious interference. Few advocate extirpation of 
the morbid focus. They prefer free cauterization with chemical sub- 
stances (potash, chloride of zinc, corrosive sublimate) or with fire. The 
efficacy of antiseptic injections — solutions of corrosive sublimate (Kitsch, 
Kovalewsky), tincture of iodine (Davaine, Cezard, Raimbert, Joly, Bala- 
doni, Chipault, Th. Anger, Verneuil, Richet), carbolic water (Chipault, 
Tr^lat, Proust, Molliere), — is established by many clinical observations. 
Since the bacterides grow well only in a temperature of about 37°, there 
has been an attempt to raise the heat of the surroundings of the diseased 
zone by the application of a warm iron, or to lower it with sprays of ether. 
The results have not been encouraging. The mixed treatment recom- 
mended for man by Verneuil includes : i. The removal or complete de- 
struction with the red-hot iron of the mortified zone. 2. The appli- 
cation of penetrating points of firing, one or two centimeters apart, all 
over the indurated part. 3. Injections of antiseptic solutions in the 
points of firing, and in the regions surrounding the swelling, so as to 
envelop it. The most highly recommended solutions are the tincture of 
iodine, pure or diluted, carbolic-acid water 1-2 per cent., corrosive subli- 
mate I in 1000. These injections are to be repeated several times a day 
and sufficiently close to each other to permit the inflammatory centers 
they produce to gather together and form a bactericide protection. Be- 
tween the injections, the lesion is covered with compresses moistened 
with a Van Swieten solution ; antiseptic baths and a spray are also re- 
commended. 

Patients must be supported with strong food, stimulants (coffee, alcohol) 
and antiseptics (cresyl, 10 grams; tincture of iodine, a tablespoonful). 

Special sanitary measures are also to be observed. 

III. 

FARCY. 

Though a morvo-farcinous infection, and under all its forms susceptible 
of cure, it is not proper, with the therapeutical resources at our command 
at present, to undertake its treatment. Sanitary law orders the destroying 
of all animals affected with glanders or farcy. With very rare exceptions, 
the specific manifestations that we observe are secondary ; .they tell of a 
condition of generalization of the infection, often when it has existed 
for a long time, so that they condemn the animal immediately. In doubt- 
14 



2IO 



Vl::rERIXARV SURGICAL TllERAPLU'llCS. 



fill cases, inoculation and malleinization assure the diagnosis. But an 
accidental cutaneous inoculation is possible, and then the evolution of the 
primitive lesion, or of the farcino^ts bud, may be observed. 

The treatment of a primitive lesion, to be efficacious, must be applied 
early, before the diffusion of the contagion ; but generally, when the initial 
lesion is discovered, the first bacilli that have penetrated in the lymphatic 
channels are already beyond reach, and sometmies the infection is rapidly 
realized through the blood. 

Free destruction of the farcinous bud or cord with the actual cautery, 
or with deep, close points of firing, subcutaneous injections and local ap- 
plications of energetic bactericide solutions, are the rules for local treat- 
ment. 

The best way to Xxq^X pse it do-farcy is by cauterization of the wounds, by 
antiseptic washes, baths, or dressings, avoiding the seat of the lesions; by 
perfect cleanliness of the affected regions, and by the internal use of iodine 
and arsenical preparations. (See Epizootic Lymphangitis. 



IV. 

TUBERCULOSIS. 

Frequent in cattle, quite common in dogs, tuberculosis is rare in 
horses, swine, sheep and goats. Among birds, it is most commonly met 
with in chickens, pheasants and parrots. The question as to whether 
the tuberculosis of animals and birds is the same in both, or different, 

is still discussed. Some bird 
species, the gallinaceous, for 
instance, are almost proof 
against tuberculosis of mam- 
malia, but on others (psittace- 
ous) inoculation succeeds easily. 
The ordinary doors of en- 
trance to the bacillus are the 
respiratory and digestive mu- 
cous membranes ; and there 
are cases where it penetrates 
through the skin. In all ani- 
mal and bird species, except in 
psittaci, external or surgical 
localizations are exceptional. 
Frohner has shown that they are relatively common in the parrot. Out 
of 56 observations made at the Berlin school, Eberlein has found lesions 
of the skin in 29 cases,-of the bones and articulations in 14, of the eye 




Fig. 54. — Tuberculosis tumor of the 
periocular regions, (from a photograph). 



TUBERCULOSIS. 



21 I 



and periocular region, in 14, of the mouth and pharynx in i i, of the tongue 
in 9, of the larynx in 2, and often in this bird the cutaneous lesions 
seem primitive. Out of 35 parrots brought to our clinics during the last 
eight months, 1 1 were affected with external tuberculous lesions, mostly 
covered with a horny layer. These lesions, as well as the bony and 
articular manifestations, are much more rare in gallinae. 




Fig. 55. — Tuberculous tumor of the wing. (Photograph), 

In cattle one sees, sometimes, tuberculous places on the skin, the sub- 
cutaneous connective tissue or bones and joints. Morot has seen in a 
bull, scattered over the whole subcutaneous cellular tissue a large number 
of tuberculous tumors, varying in size from that of a pea to that of a 



<^' 



^ 



^ 



J^S^^^SSrtfe^. 



\^' 




^.^, 



Fig. 56. — Horny growth on a tuberculous surface of the cheek (from a 
plate of Krampf ). 

nut. The testicle and lungs were healthy. Langdon Trothingham has 
observed in a cow numerous tumors of the skin which ulcerated and 
cicatrized ; they were rich in baccilli and resembled the lupus of man. 
Muscular tuberculosis is extremely rare ; few observations of this disease 



212 VETERINARY SURGICAL THERAPEUTICS. 

on cattle and only one on a horse are on record (Cadiot, Gilbert and 
Roger). 

External tuberculosis is also rare in dogs. Miiller has reported one case 
analogous to one of ours. It was that of a seven-year-old slut belonging 
to a consumptive ; she had shown first at the lower part of the neck a 
subcutaneous tumor as big as an egg, which later on softened and gave 
rise to a fistulous wound. External tuberculosis in cats has been recorded 
by Nocard and Jensen. (See Tubercular Arthritis?) 

The diagnosis can be established with certainty by a bacterioscopic ex- 
amination. Injections of tuberculine give also rare results. 

Upon the statements of Louis, it was believed for a long time that 
surgical tuberculosis existed always with an infiltration of the lung, and 
that consequently surgical interference was useless. But recent observa- 
tions have shown that the tuberculous virus remains sometimes for a 
certain length of time isolated in the place where it has been deposited, 
and that the extirpation of the primitive focus may be followed by re- 
covery. 

For tuberculous cattle sanitary laws prescribe special measures. 

As a general rule tuberculous affections of other species are dangerous 
to man ; veterinarians must advise their being destroyed. In the rare 
cases, where he must interfere for small animals or fancy birds, he will be 
guided by the rules for the treatment of tuberculosis in the case of man. 
Against the lesions of the skin and of the connective tissue, one must not 
stop at local applications, light cauterizations, or antiseptic applications, 
but must have recourse immediately to the eradication of the diseased 
center, which continually spreads the germs of contagion in the surround- 
ings. The lumps of lupus, ulcerated tumors or cuta?ieous grotvths should 
be fully removed. The actual cautery should be employed instead of the 
bistoury, which opens the blood vessels and exposes the system to secon- 
dary inoculations. The wounds should be treated afterwards with iodo- 
form. A local relapse implies a new exeresis. If the surrounding glands 
are involved, they must be removed. 

Also bony lesions should be treated by excision and the use of the 
curette. Fungous arthritis should be treated by immobilization of the 
joint and injections of iodoformed vaseline into the fistulaer those of 
chloride of zinc (i-io) into the zone neighboring the morbid center 
(scleragenous method of Lannelongue). 

Hygienic and medical treatment must go along with the surgical in- 
terference. Good feeding, cod-liver oil, creosote and guiacol, also in- 
jections of creosote or gayacoli oil are excellent adjuncts of treatment. 

• 1 Eberlin, Monatschrift fiir Thierheilkunde, 1S74, p. 261. 



CHAPTER V. 
TUMORS. 

The etiology and pathogeny of tumors are still more obscure in the 
case of animals than in the case of man. The influence of herediiy, ad- 
mitted to-day almost without question by numerous and well-observed facts 
for carcinoma of man, seems also established for the other malignant 
tumors. Transmitted neoplastic diathesis may, however, give rise among 
offspring to neoplasms of the same nature as those developed in the 
parents, or of a different type. We have watched a slut operated upon 
twice a year apart, for cancer of the mammae ; her two daughters had a 
mammary tumor, one at four, the other at five years old. But few cases of 
this kind have been published, evidently because the previous and special 
clinical history of our patient is difficult to obtain and generally incomplete. 
Species has an undoubted influence. Although, indeed, all animals are 
subject to tumors, they are not subject to them with like frequency. 
Carnivorous animals and solipeds have them more commonly than rumi- 
nants ; in certain species (dogs in particular) females are more exposed 
than males by the great proportion of 60 per cent, of the mammary 
tumors in females. Age plays an important part as predisposing cause. 
One hundred observations gathered by us of tumors in dogs are classified, 
according to age, as follows : Below three years, 6 ; from three to five 
years, 18; from six to nine, 33; from nine to twelve, 26; from twelve 
to fifteen, 14 ; from fifteen to twenty, 3. Therefore tumors are frequent 
in old animals, rarer in those of middle life ; exceptional in young animals. 
But as each age has its diseases, it has also its tumors ; in young sub- 
jects, benignant tumors are almost the only ones observed (polypi, papil- 
lomata) ; sarcoma is seen in adults and in all species, but carcinoma is 
certainly the neoplasm of the old. 

It seems, also, that hygienic conditions to which animals are submitted, 
the rtgime especially, has an influence on the genesis of tumors. As 
Leblanc remarked, dogs that are fed on meat and deprived of exercise, 
kept tied up or indoors, are oftener affected with tumors than others. 
But it is useless to say that one can at will produce cancers in certain 
species by imposing upon them a special rcgivie'sivA mode of living; such 
an assertion rests upon no carefully established fact. 

213 



214 VETERINARY SURGICAL THERAPEUTICS. 

It has also been observed in animals that there exist close relations 
between cancer and arthritisjn. In some cancerous subjects whose ante- 
cedents have been known, it has been found that the history of more or 
less serious troubles was related to eczema or to arthritism. We treated 
a dog whose clinical history was minutely recorded. He died when four 
years old with generalized sarcoma, having shown at various times tem- 
porary lameness, in various locations, of a rheumatic nature, and this lame- 
ness appeared alternately with eczematous eruptions. Without the action 
of any violent cause, he became affected with sarcoma of the neck and of 
the femur, and died three months later. Trasbot has mentioned two ob- 
servations in which arthritism and tumors succeeded each other at long 
intervals. With these rare facts, how many others there are in which 
cancer develops without being preceded by lameness or eczema, or 
any other arthritic disorder ! The history of tuberculosis imposes the 
greatest reserve in the recognition of these etiological influences. It 
would not be at all surprising if some day experimentation would throw 
them back into the domain of imaginary causes. 

Tumors appear, ordinarily, on organs or on external parts exposed to 
mechanical irritations ; these, with general traumatism, have been con- 
sidered the cause of their formation. But if, in a great number of 
cases, the influence of secondary causes of a mechanical nature can be 
accepted as a theory, it is far from being an established fact, and often 
this influence cannot even be brought into the question. Careful obser- 
vation and experiments have shown, besides, that traumatic irritations are 
not sufificient to create neoplasms, especially malignant tumors. Almost 
all the neoformations which, in horses, appear on regions where the 
harness rests are chronic inflammatory lesions or botryomycosic products. 
The same is true of those which occur in other regions by the influence of 
frictions, pressures, slight and repeated contusions. In old sluts affected 
with chronic eczema, mechanical irritation applied on the mammae and 
bruises, repeated every day, or every other day, for months, have failed to 
promote the formation of neoplasms : only an inflammatory swelling, 
sometimes an abscess, followed. Consequently, traumatism itself seems to 
act only as secondary cause. 

"The recent discoveries made in the domain of infectious diseases 
have resuscitated the old doctrine of parasitism of tumors. A great simi- 
larity exists between the lesions of several parasitic diseases (actinomycosis, 
tuberculosis) and those of infectious malignant tumors; yet, up to the 
present time, there is nothing to show that the two processes are identi- 
cal. Except the epitheliomatous graftings of rat upon rat, obtained by 
Moreau, and the successful grafts of polypi among dogs by Duplay and 
Cazin, all attempts to inoculate malignant neoplasms have either failed 



TUMORS. 215 

or given only doubtful results. The numerous experiments that we have 
been making for the last four years for the purpose of transferring neo- 
plasms from man to the dog, from horses to horses and dogs, from dogs 
to dogs, rabbits, guinea-pigs and hens, and from chicken to chicken, — all 
have failed completely : we have not even succeeded whefi tryitig to graft 
upon cancerous dogs fragments of their own tumor. Let us add, however, 
that we have transferred to three dogs, by rubbing the mucous membrane 
of the penis, papillomatous vegetations developed on the penis of another 
dog; but these productions remained local, decreased and disappeared 
of themselves. If these negative results do not allow one to deny the 
parasitic nature of cancer, they suggest changes in the experimental 
methods, since they tend to demonstrate that it is not by increasing the 
inoculations made in the ordinary way that the problem is to be solved. 
In man some observations have been mentioned which seem to establish 
the. contagiosity of cancer; we have never observed anything like it in 
animals." ' 

In animals, as in man, tumors may appear on parts the most different, 
but they have a well-marked predilection for the skin, some mucous mem- 
branes and glands, the mammae in particular. The testicle is, after the 
mammae, the organ most often affected. The ectopia of this gland pre- 
disposes it to neoplastic degenerations : cancer of the testicle is quite com- 
mon in monorchid and cryptorchid horses. Neoplasms are also quite 
common in the mouth, nasal cavities, sinuses, on the penis, the tail, the 
arms, on the inferior regions of the extremities, on the eye, in the thyroid 
or parotid glands, and on bones. Cancer of the tongue is extremely rare 
in animals ; that of the lips is sometimes seen in old dogs ; that of the 
uterus, so common in woman, is exceptional in female domestic animals. 

All visceral cancers are much rarer than was formerly believed. In a 
great number of observations made upon tumors of the thoracic or abdomi- 
nal organs, the lesions revealed in reality tuberculosis. This error has 
been current for a long time in the case of dogs^ v/here tuberculosis is 
ordinarily manifested by large products developed in the viscera (liver, 
lungs, kidneys) , lymphatic glands and serous membranes. It may yet 
persist, even with histological examination, which reveals a structure 
resembling sarcoma or lymphademia more than tuberculosis ; it is only by 
the discovery of the bacilli and inoculation that the true nature of these 
products can be made out. Cancer of the liver and of the kidneys are 
the only ones which are frequently met with ; that of the stomach is 
exceptional. In the inquiries which we have been making for several 
years, we have found, in the dog, several series of 10, 12, 15 cases of 

1 Cadiot, Gilbert and Roger : Les tumeurs malignes chez les animaux. — Presse 
Medicale, 1894, p. 219. 



2l6 VETERINARY SURGICAL THERAPEUTICS. 

tuberculosis with lesions extending over a greater part of the viscera, with- 
out meeting a single case of true generalized neoplasm carcinoma or 
sarcoma). The same remarks apply to the horse ; numerous cases of 
"sarcoma," and of "cancer," belong, in reality, to the group of bacillar 
lesions. 

Most of the authors who have written upon the relative frequency of the 
various varieties of tumors declare sarcoma to be more common than 
carcinoma. The statistics of Semmer (1888), made from 57 malignant 
growths collected by him about various animals, counts 32 sarcomas 
against 25 carcinomas. Our researches, made more particularly among 
dogs and horses, have given results somewhat different from those of 
Semmer. " Out of 44 malignant tumors — 38 from the dog, 5 from 
the horse, and i from the cat — we have found 32 epitheliomas and 12 
sarcomas " (Cadiot, Gilbert and Roger) . In dogs especially, epithelial 
tumors are the most frequent. Frohner found out of 643 cases of tumors 
removed at his clinics, 262 carcinomas and only 44 sarcomas. We may 
add that, although in all species generalized sarcomatosis seems m.ore 
common than carcinomatosis, it is evident that the difference is not so 
great as was believed up to the present time : that which has especially 
created and propagated this error is still the confusion established be- 
tween tuberculosis and generalized sarcomatosis. We must, however, 
make exception for the melanosis of horses, which is very generally of a 
sarcomatous nature (Cornil and Trasbot). 

Considered from a clinical point of view, tumors must be divided 
into be7iign and malignant, and into solitary, jnultiple and infectious. 

By benign tumors is understood those that remain circumscribed and do 
not grow worse or return only by exception after they have been re- 
moved. Malignant tumors have a more rapid development, a marked 
tendency to spread, and give rise to secondary growths in their neighbor- 
hood or at some distance from them. Most commonly they grow worse. 

A tumor is solitary when it is alone and benign. The neoplasms are 
called multiple that develop in a larger or smaller number in the same 
organ or the same systems of tissue. Infectious tutnors, the most malig- 
nant of all, are soon accompanied by secondary neoplasms in their near 
neighborhood, in lymphatics, surrounding glands, or in the viscera : they 
become generalized through the lymphatic or venous channels, by a 
mechanism still undiscovered (infection or embolics). The neoplasms 
of this last group, which belong to various histological types, present 
great differences in their evolution and their tendency to generalization. 
Some, while spreading over the region where they first develop, remain 
in it some time confined, without any effect upon the surrounding 
glands ; infection, when it occurs, taking place ordinarily by the venoug 



TUMORS. 217 

channels (sarcomas) ; others extend along the lymphatic vessels and stop 
at the first group of ganglia they reach (epithelial cancer) ; and others 
advance rapidly into the lymphatic vessels, and by a very active pullulation 
are soon spread over most of the viscera (encephaloid cancer). It is 
known that tumors that are rich in cells but little developed, and greatly 
resembling embryonic forms, are the most malignant and infectious. 

With tumors of the same nature (carcinomas, sarcomas, or melanomas) 
the gravity and the tendency to generalization are almost always in direct 
proportion to the rapidity of development of the primitive tumor. Gener- 
ally, in animals, carcinoma grows more slowly than sarcoma, although in- 
fecting little by little the lymphatics that sarcoma would respect. The 
skin is less often attacked by subcutaneous sarcoma than by carcinoma ; 
its ulceration also is more rare and slower. Although while encephaloid 
carcinomas are seen developing very rapidly, and sarcomas remain local- 
ized for months, even for years, without disturbing the general health, it 
is nevertheless true that sarcomatosis develops more rapidly as a rule. 
The dog, of which we spoke above, affected with sarcoma of the penis, 
died from extensive lesions three months after the appearance of the origi- 
nal neoplasm; 2,200 tumors were counted on the surface of the lungs. 

The prognosis of neoplasms, extremely variable, depends upon their 
nature, their seat, the rapidity of their growth, the integrity or invasion of 
the surrounding lymphatics, and the general state of the patient's health. 
Microscopical examination does not always allow the making of a prognosis 
in a positive manner. Exceptionally one will meet with fibromas of rapid 
growth and of a spreading tendency, and with others that recidivate. 
Epithelial tumors with nearly similar histological characters have been 
seen acting in different ways — some developing very slowly and remaining 
local, others spreading, recidivating and infectious. On the other hand, 
tumors truly malignant according to their histological characters have been 
observed whose cure was brought about by early and complete removal. 

At any. rate, a determination of the nature of a certain number of tumors 
by microscopical examination is somewhat difficult for one who has not 
made a special study of that portion of pathological anatomy. 

In general, whatever may be the nature, age and seat of tumors, ablation 
or destruction by caustics is the only efficacious mode of treatment. For 
benign growths, the interference of the surgeon varies according to the 
clinical character of the neoplasm and the region it occupies. It is pru- 
dent to leave alone indolent, stationary or slowly progressing tumors loca- 
ted in regions where they give rise to no inconvenience. If they are, 
however, well pedunculated, they can be removed with the ecraseur or a 
non-extensible ligature. If they are small and do not spread at their base, 
the red-hot iron or potential caustics (potash, chloride of zinc, arsenious 



5l8 VETERINARY SURGICAL THERAPEUTICS. 

or mineral acids) are sufficient to destroy them. When they are wide and 
flat or intimately implanted in the tissues so that their removal is to be 
made with the bistoury, one must carefully weigh the possibility of com- 
plications following the interference. Serious and even fatal accidents 
may occur from bloody exeresis of a benign and painless neoplasm which 
did not trouble the patient and might never have caused serious incon- 
venience. Should there be an oversight in the operation, septicaemia may 
occur from the wound made by the removal of an old neoplasm, whose 
slow growth as well as clinical manifestations positively indicated its 
benignity. Therefore, for these tumors, abstention ought to be the general 
rule. Let us remark, however, that tumors which may have remained 
benign for a long time, may at a given time rapidly enlarge and spread ; 
as soon as this transformation takes place, they evidently return to the 
category of the malignant tumors and must be treated as such. Pedun- 
culated tumors of mucous membranes easily explored (nose, rectum, 
vagina) should be removed with the ecraseur or torn off with the fingers. 
During the last few years, the prophylaxis of cancer has been much 
talked about ; but we have seen that, aside from heredity, there are no 
positive etiological data to admit it. It has been believed that cancer is 
more common in man since meat has entered in a greater proportion 
into general alimentation ; hence the advice to eat less meat and a greater 
proportion of vegetables — a piece of advice which could be put in practice 
with dogs and cats if facts justified it. The relative frequency of can- 
cerous growths among subjects affected with arthritis has suggested the 
use of arsenical or alkaline substances, either as therapeutic agents of the 
" neoplastic diathesis " or ,as prophylactic medication of carcinosis. Up 
to the present time nothing proves the real efficacy of these means. 

At all times the cure of malignant tumors has been tried by the use of 
a great variety of applications and by a no less varied assortment of in- 
ternal medications. Chlorate of potassium in powder or in saturated solu- 
tion seems to be effective against some epithelial growths ; some results 
have been obtained in cases of cancroids of the skin or the tegument of 
natural openings, but they fail with the epithelial growth of mucous mem- 
branes. If papillomas of the mouth in dogs and the growth of the lip of 
the cat, improperly called "cancroid," do ordinarily submit to the action 
of chlorate of potash, it is known that those growths are exceptions to the 
general law of the persistency of neoplasms ; after a variable length of time 
almost always the ulceration of the cat's lip stops in its growth and heals ; 
in the same manner the warts of the buccal mucous membrane of dogs 
shrink and disappear; it is rarely necessary to treat them actively. 
Against the ulcerated epithelial tumors of the lips, aniline colors can be 



TUMORS. 21^ 

tried, in particular the solution of methylene blue ; treatment recom- 
mended for man by Mosetig-Moorhof and Darier.' 

Arsenical preparations (Fowler solution, arsenious acid) and iodine, 
recommended against sarcomas and lymphadenomas, have but little efficacy. 
We have often used them without the slightest advantage. Iodide of 
potassium has never produced a satisfactory change in the growth of 
neoplasms ; it rather seems to stimulate their growth by the disturbances 
it gives rise to. As local applications, or to be taken internally, a number 
of compound mixtures, " antineoplastic " plants have been recommended, 
all without the slightest use. Electricity, which has given some success- 
ful results in the therapeutics of the uterine tumors of women, has not 
been much used in veterinary practice. 

Some microbian inoculations have also been proposed for cancer. 
Among these it has been said that the streptococcus of erysipelas injected 
into sarcomas and carcinomas could arrest the process and bring on re- 
covery, the tumors becoming affected with fatty degeneration and disap- 
pearing. We know also that this result has taken place spontaneously 
without those injections. Bacteriotherapeutics seems to have succeeded 
only in cases of such nature. 

At the present time the only rational therapeutics of malignant tumors 
is extii-pation. To obtain all that it can give, it must be radical and early. 
To make it radical, one must bear in mind that almost all these growths 
are surrounded by a zone infiltrated with neoplastic elements, though no 
alteration manifest to the naked eye can be observed in them. When 
secondary tumors are already developed round a diffused primitive 
neoplasm, the latent zone of infection may at times be very wide and 
then the ablation must be quite extensive. If the skin is more particularly 
the seat of this neoplastic infiltration this extends deeply into the con- 
nective lamellae on the surface of the aponeurosis and into the thickness 
of all the tissues of that region. Independently of this zone of infection 
which surrounds the tumor, there is another formed by the blood vessels 
and the surrounding lymphatic glands ; the latter is almost always rapidly 
overrun with the neoplasms of epithelial origin ; often it is already infected 
when exploration fails to reveal any alteration ; most often, however, the 
lymphatic vessels show small nodosities here and there along their length, 
and their collecting glands are hypertrophied and indurated. In such 
cases the removal of the growth must necessarily be completed by that of 
the infected lymphatic structure. Numerous are the mammary neoplasms 
of sluts that demand such extensive removals. The trouble must be fol- 
lowed up in the groin to its roots. Some of the diseased glands cannot 
be reached ; operation is then powerless to bring about recovery. It is 

I Mosctig-Moorhoff^ Darier; Semaine Medicale, 1894, pp. ?28 and 238, 



220 VETERINARY SURGICAL THERAPEUTICS. 

the same for old tumors of the mouth, of the nasal cavities, for those of 
the testicle, the anus or the rectum. For a greater reason, when the 
tumor is already more or less generalized, when the patient is weak, in a 
cachectic condition, interference is forbidden, as not only would the 
operation be a failure, but it would accelerate the progress of the 
disease. 

Interference is also to be forbidden when the neoplasm, located in 
some regions, has extended far into the subcutaneous layers. In sluts and 
female cats, ulcerated mammary tumors are found which have invaded the 
entire thickness of the abdominal wall, and whose removal could not be 
performed without removing a large portion of this wall. 

Then, again, there are tumors which, though circumscribed and of small 
extent and depth, and not involving the lymphatics, do not justify ex- 
tirpation : these noli me tangere recidivate immediately, develop more 
rapidly, and are endowed with a more marked infecting power than pre- 
vious to the interference. The seat of the neoplasm sometimes imposes 
abstention from operation ; animals affected with malignant tumors of 
the mouth, of the sinuses, the larynx, the oesophagus, or the rectum 
must not be operated on. The prognosis is sometimes aggravated by the 
age, and by some morbid conditions (albuminuria, cardiac affections, 
diabetes). 

Once decided upon, the operation must be performed with all anti- 
septic care. If the tumor is ulcerated, it should be disinfected with a 
strong solution of chloride of zinc, the suppurating surface should be 
curetted as well as the fistulous tracts, if they exist. For ablation, the 
bistoury will be preferred ; it is better than any other instrument, because 
it will permit a total and methodical excision. The large blood vessels 
should be obliterated with forceps and ligatures, and the hemorrhages 
of capillaries should be arrested with actual cauterization. In dangerous 
parts, a careful dissection will allow one to avoid the arteries, veins and 
important nerve branches yet unaltered. With some tumors, enucleation 
with the blunt probe or the finger is advantageous where connective layers 
exist. No neoplastic nucleus should be allowed to remain ; all invaded 
lymphatic glands or vessels should be taken off. 

Excise all that is morbid, all that seems diseased ; remove the im- 
mediately surrounding layer, which is often affected with neoplastic ele- 
ments to a depth, at times, a centimeter thick, and only stop when sound 
tissue is reached. Such is the rule, which must be strictly observed. In 
leaving a suspicious cutaneous fragment, or a piece of doubtful tissue, re- 
lapse is to be feared. After carefully cleaning the wound and com- 
pleting the hemostasis with actual cautery, it should be dusted with 
iodoform, or a mixture of tannin and iodoform, its edges brought together 



TUMORS. 221 

with separated sutures, and the whole covered with a coat of collodion or 
with a dressing. 

In every case, if possible, and even if the solution of continuity has to 
be large, complete extirpation should be made at one sitting. There are 
cases when successive interferences are necessary to remove a neoplasm in 
its entirety, and then there remains, in some parts of the large wound, 
small spots of repullulation which demand another surgical operation 
with the bistoury or the actual cautery. Quite often in sluts, notwith- 
standing the total removal of mammary tumors, another interference is 
necessary after a variable length of time ; and even then the patient cannot 
be saved. 

Although we possess a certain number of observations on radical cures 
of neoplasms which histology had declared incurable, it is, nevertheless, 
true that the recidivity of malignant tumors is the general rule. 

Let us now consider the special methods of treatment of the various 
kinds of tumors. 

Fibromas, which are to be placed among the most benign growths, re-* 
cidivate but very rarely after removal, and when they do they affect the 
structure of sarcomas. Some retrogressions are also explained by errors 
of diagnosis : carcinomas or sarcomas which had undergone fibrous trans- 
formation or growth were mistaken for simple fibromas. The ablation 
of fibromas is ordinarily done with the bistoury : if the wound remaining 
is small, first-intention cicatrization is possible. When the tumor is 
pedunculated, the ecraseur or elastic ligature can be used. The slow 
action of this latter, the putrefaction which takes place in the tumor 
before its complete section, and the fetid odor coming from it are objec- 
tionable ; for these reasons it is advantageous to combine ligature with 
excision ; twenty-four or thirty-six hours after the application of the ligature 
the tumor is cut ofif close to the ligature and the stump left to its 
spontaneous slough. Sometimes the actual or the thermo cautery are used 
also. Some sessile diffused fibromas may also be destroyed by actual or 
potential cauterization. 

Circumsaibed myxomas are treated by total removal with the bistoury 
or ecraseur; sometimes they are torn off with the fingers. Diffused 
myxomas demand a careful dissection of the roots which extend into 
muscular spaces. The former rarely recidivate, the latter more com- 
monly. When they do, the new growth ordinarily offers the structure of 
a sarcoma. For small animals, if a myxoma of a leg returns, amputation 
is better than a second removal. 

When lipomas are large and troublesome they are removed with the 
bistoury. The operation is very simple for circumscribed, but rather 



222 VETERINARY SURGICAL THERAPEUTICS. 

difficult for dififused, lipomas. If the tumor is voluminous, an elliptical 
cutaneous flap is removed with it. Union by first intention or sutures 
with drainage, according to the extent of the wound, complete the removal. 

Papillomas are generally not serious. They are destroyed with the 
bistoury or the ecraseur (ligature with silk threads) when well peduncu- 
lated, or repeated cauterization of nitric acid. Radical recovery of 
warts and cutaneous growths require ordinarily the removal of a portion 
of the skin where they are implanted. Papillomas of the mucous mem- 
branes (vulva, vagina, uterine neck) are treated with excision ; some- 
times they return and require being operated upon again after a variable 
length of time (weeks or months) ; but even in these cases radical recovery 
is not rare. 

For cysts two methods can be employed : (i) Extirpation of the growth ; 
(2) evacuation of its contents, and local application of agents to promote 
the granulating inflammation of the walls of the cyst, the obliteration of 
its cavity, and the shrinking of the walls of the sac. 

Extirpation with the bistoury is the surest and quickest way, and ought 
to be used whenever the operation can be performed easily and without 
danger. Elastic ligature is advantageous for some pedunculated cysts. 
The other mode of interference includes several ways. For serous and 
most mucous cysts, the evacuation of the contents by a capillary puncture 
and the injection into the cavity of an irritating fluid (pure or diluted 
tincture of iodine, a strong carbolic solution) are at times sufficient ; 
after the injection, especially if before the removal of the injected fluid 
the tumor has been kneaded by the surgeon, the wall of the sac has be- 
come inflamed and vascular, a sero-fibrinous exudation takes place ; 
then gradually this serosity is absorbed, the walls of the sac retreat and 
the cavity disappears. The free incision of the wall of the cyst is another 
process which brings on recovery in a dififerent manner : the cystic mem- 
brane, then exposed, loses its epithelium, suppurates, is covered with 
granulations which fill the cavity, thus constituting a more or less volumin- 
ous mass of embryonic tissue which afterwards becomes organized and 
contracts. Multiple punctures and capillary or tubular drainage bring on 
the same result ; sometimes recovery is slow, but it can be stimulated 
with irritating injections into the cavity. Deep cauterization, which also 
gives good results, is especially advised when the walls of the cyst are 
thickened by previous unsuccessful treatments. 

Sarcomas require early, entire removal, which even does not insure 
against their return. Still, recovery in numerous cases follows a single 
well-performed operation. When this is performed for sarcoma of soft 
parts, one must bear in mind that the fibrous capsular sheet, which ordi- 
narily isolates the morbid tissue, is part of the neoplasm and envelops it 



TUMORS. 223 

entirely. An iodoform dressing with or without drainage should follow. 
We have found no especial efificacy in arsenious acid ; its so-called specific 
action on sarcomatous elements remains to be demonstrated. If there 
is a relapse, interference must be renewed as early as possible. Sar- 
comas of bones almost always return, even when resection extended be- 
yond the limits of the neoplasm. In the case of small animals affected 
with sarcomas of the legs amputation is advised. Melanotic iiitnors should 
be operated upon only when they give rise to functional disturbances, in- 
terfere with deglutition, micturition, defecation, or with the work of 
animals. 

With epitheliomas and carcinomas, radical and early removal is also 
the only treatment likely to arrest the disease ; but interference is to take 
place only when the entire excision of the growth and ganglionary sur- 
roundings is possible. One should remove the neoplasm, the surround- 
ing latent zone of infection, the indurated glands and those that are sus- 
picious, and also the lymphatic vessels connected with the tumor. The 
excision should always be made freely, including even healthy structure ; 
the edges of the wound should then be broup;ht together by suture and 
an iodoform dressing, with or without drainage, be applied. Ulcerated 
epithelial tumors on the toes of dogs, ordinarily yield only to amputation 
on the metacarpal region ; excision only of the diseased toe is insufficient. 
When total ablation is not possible, it is useful, in some cases, for in- 
stance where there is ulceration, to make a partial excision in order to 
facilitate the cleaning of the wound and relieve the pain (dog), but absten- 
tion is the rule. Interference is always to be forbidden in diffuse cancers, 
enormous multiple growths and in cases when infection is of generalized 
tendency. 

The removal of enchondromas and osteomas should be performed only 
when the disease progresses rapidly and causes functional disturbances. 
Enchondroma of soft parts rarely returns after complete extirpation ; that 
which develops in the superficial layers of bones is scraped off. If there 
is a relapse and the growth affects a bone of a leg, amputation is required 
in the case of small animals. Osteomas which cause no pain or interfer- 
ence are left alone. 

With lymphadenomas abstention is the rule. The tumor returns in a 
short time or new ones develop in other regions. In supposed cases of 
cures of lymphadenomas by surgical interference, it is probable that the 
ailment had been given a wrong name. Internal arsenical treatment, 
recommended for lymphadenia, is powerless in domestic animals. 

For myomas and neuromas which are painful and interfere with func- 
tions, extirpation must be attempted if not too difficult. Tumors de- 
veloping on the nerves afterneurolomyarenot true neuromas, but chronic 



224 VETERINARY SURGICAL THERAPEUTICS. 

inflammatory neoformations, which are at times accompanied with great 
pain or lameness, and must be resected. In general they can be avoided 
by giving to the wound of operation all the conditions required for immedi- 
ate cicatrization ; their return is prevented in the same way. 



THIRD PART. 

DISEASES SPECIAL TO EACH TISSUE. 



CHAPTER I„ 

SKIN AND CELLULAR TISSUE. 

I. 

TRAUMATIC LESIONS. 

EXCORIATIONS — CORES — STICKFASTS. 

We shall say nothing of hj-uised or ordinary cutaneous wounds. Their 
treatment requires no special attention. 

Excoriations, so frequently observed during the warm season on the 
parts of the body which carry the various pieces of harness, are ordinarily 
made by their direct action upon the skin moist with perspiration ; 
the epidermis adheres to the harness, becomes loose, and the Malpighian 
and papillary layers of the skin are exposed. The uncomfortable itching 
following gives rise to repeated rubbing on the part of the animal, and be- 
comes the frequent cause of complications when the lesion exists on the 
withers, the neck or the poll. 

Very simple attention is necessary to obtain cicatrization. The injured 
region should be relieved of the pressure of the harness ; if this is on an 
animal whose work can be stopped, it should be left for a few days in the 
stable ; if it has to be kept at work, the saddle or the collar should be 
chambered or padded on each side of the injuring part of the harness 
to relieve the pressure. That removed, the excoriation becomes covered 
with a yellowish or brownish scab and rapidly cicatrizes. In case the 
lesion is extensive and looks bad, recovery may be accelerated by antisep- 
tic lotions or epithems, or applications of vaseline or glycerine. Cocained 
vaseline can be used if the itching is very great. 

The skin of the regions which are the seat of pressure or repeated rub- 
bings — surfaces on horses which carry the harness, on cattle the yoke, and 
the plantar cushion of a dog's paws — present sometimes circumscribed epi- 
dermic neoformations moreor less elevated, with irregular edges, analogous 

in their pathogeny to the corns of men ; they are called cores. Surround- 
15 225 



226 VETERIXARV SURGICAL THERAPEUTICS. 

ing them the hairless skin is covered with a dry, horny, hard and irregular 
patch, which results from the hypertrophy of the horny layer of the 
epidermis. Generally, the deep face of this core is fiat, the mucous layer 
and the dermis remain intact or slightly altered ; it is possible, however, 
that the papillary coat is involved in old and extensive cores, and that 
they remain even after the removal of the cause that has produced them. 
Except in rare cases, cores of our large animals are painless, and do not 
interfere with their use. It is not so with those of the paws of dogs ; 
they have deep roots, which consume the papillae, thin the dermis, and 
give rise ordinarily to severe lameness. 

Cores due to the harness, most commonly giving rise to no serious im- 
pediment, are not treated ; it is, however, important to prevent the in- 
crease of the trouble by improving the condition of the harness, with new 
padding, for instance. Painful cores must be relieved of all pressure. 
The thinning of the epidermic plate with the bistoury, and applications of 
vaseline, glycerine or salicylic collodion are ordinarily used. Cauterization 
with mineral acid or the excision of the cutaneous spot is seldom necessary. 

In dogs, the cores of the paws are treated with paring, warm baths, 
and the repeated applications of salicylic collodion. 

On the surfaces where the skin is much pressed by certain pieces of 
harness (saddle, collar, surcingle), spots of dry gangrene may develop, 
of which we have already spoken in the article on Gangrefie, and which 
are known as stickfasts. This expression does not apply to epidermic 
growths, but, on the contrar}', to lesions of necrotic order. 

Their pathogeny is known ; badly padded or improperly fitting har- 
ness presses hard on the skin and promotes a permanent ischsemia and cel- 
lular disturbance, which end in mortification of a more or less extensive 
cutaneous spot, generally circular in shape. If the pressure continues, 
the tegumentary spot, which is necrosed, dried and hardened, transmits it 
to the tissues underneath, which in turn become successively necrosed ; 
thus is explained the formation of the deep stickfasts of the withers, of 
the neck, and of the poll, accidents that we shall consider later. 

The sloughing of the mortified skin takes place as in all cases of limited 
dry gangrene. It rarely requires more than twelve or fifteen days, when 
the necrosis does not extend beyond the subcutaneous connective tissue. 
The wound heals by granulation. 

Stickfasts are prevented by watching the condition of the harness and 
its paddings. As soon as the mortification sets in, its spreading is pre- 
vented by removing the pressure made on the spot ; the animal should, 
according to the case, be kept out of work for a certain length of time, or 
the harness should be so altered as to prevent any further mischief. 
Though this may often be sufficient, it is better to accelerate the cure by 



ERYTHEMA. 22; 

the application upon the diseased part of vaseline simple, or mixed with 
an antiseptic substance (cresyl, carbolic or boric acid). If there is pain, 
cocaine preparations should be used. 

To stimulate the sloughing of the stickfast, vesicating preparations 
(simple blister, mercurial or bi-iodide of mercury ointment) are often 
used. These agents stimulate the progress of the inflammation, and 
noticeably relieve the pain when it is great. The sloughing completed, 
cicatrization of the wound follows soon afterwards. At times a certain 
sensitiveness remains in the region where it took place ; this gradually 
diminishes, and its disappearance can be hastened by a slight blister. 

On the superior border of the neck, on the surface of the implantation 
of the hair of the mane, there appears sometimes, after an eruption of 
acne, a certain number of Httle necrotic spots on the superficial layer of 
the skin. These have their seat principally in the bottom of the cutane- 
ous folds that are found in some horses at the boundaries of the neck and 
the withers. They are very painful during the time required for their 
elimination (Bouley and Nocard). 

These miliary necrotic spots of the neck are generally found in animals 
that are badly kept. Their skin is generally covered with a greasy sub- 
stance, irritating, and formed of epidermic detritus, dust and fluid exuda- 
tions. A thorough washing with soap and tepid water is first to be pre- 
scribed ; this should be followed by applications of vaseline, mercurial 
ointment or a vesicating friction of mercurial blister, in order to stimulate 
the sloughing of the necrosed skin. After five or six days this should be 
assisted by frequently repeated warm fomentations, and afterwards by 
simple or iodurated glycerine. In the generality of cases, a cure is obtained 
by simple cleansing of the skin. 



II. 
ERYTHEMA. 

It is of rare occurrence in large animals, where it is seen only on hair- 
less surfaces, but is quite common in animals whose skin is free from 
pigment (sheep, pigs, cats and dogs). It may be seen on any part of the 
body, and is characterized by a congestive redness which temporarily 
disappears under pressure, and by a rather strong itching. The region 
is soon hot and tumefied, and cutaneous sores and suppurations may follow. 

When erythema is produced by mechanical causes (pressure, friction, 
clipping), or by chemical (irritating therapeutic applications), it is cir- 
cumscribed ; on the contrary, it is ordinarily diffused when it is due to 



228 VETERINARY SURGICAL THERAPEUTICS. 

thermic irritations. Solar erythema, frequent in tropic regions, assumes 
this latter form. 

In horses, swine, and especially sheep, under the double influence of 
feeding with buckwheat and exposure to the sun, a diffuse erythema 
may develop, often complicated with bullate, phlegmonous or gangrenous 
dermatitis. Upon cattle and sheep fed on buckwheat, and having vesicular 
cutaneous eruptions, Wedding observed that the lesions were so much 
the more marked as the subjects had less pigment, were whiter, or were 
exposed to direct solar or diffused light. Animals that were kept in the 
dark did not have any eruption. Piebald-colored animals were not afifected, 
except on the white parts of their tegument. A cow covered with tar 
on one side of the body took exanthema only on the other side.' 

The treatment, above all, must be prophylactic ; it has various regula- 
tions. Clean the skin, prevent its mechanical irritation, guard the animals 
against a too hot sun, keep them under trees or in places where they 
are not exposed to reflections of the light, protect the head with a hood, 
cover the parts with vaseline, or use the decoction of henna {Latasonia 
i7ier?iiis), with which Arabs dye the white regions of the body of their horses 
and protect them from solar erythema.^ 

When erythema is due to feeding on buckwheat, this must be changed, 
the animals kept out of the sun, and taken out only in the evening or 
in cloudy weather. The disease has a natural tendency towards resolu- 
tion. This will be promoted by astringent lotions (acetate of lead, tannin, 
sulphate of iron) or by cold irrigations. Applications of glycerine, vaseline 
with boric acid, lead and zinc salts are used. Often it will be sufificient to 
dust the erythematous surface with starch. If the itching is severe, cocained 
vaseline or nitrate of silver solution, 5 per cent., can be used. 

Extensive oedemas, subcutaneous phlegmons and cutaneous gangrene 
are possible complications. Severe erythematous inflammation of the skin 
demands the use of antiphlogistics (irrigations, cold compresses), or of 
disinfecting solutions, when the phlegmasia is suppurative or gangrenous. 

The erythema which occurs in horses, on the axilla or the groin, under 
the influence of work when the skin is covered with perspiration and dust 
— intertrigo — gives way rapidly to the simplest treatment : rest, washing 
the parts with tepid water, dusting them with starch or starch and sub- 
nitrate of bismuth. When the exudation has disappeared, the dry, scaly 
skin must be covered with vaseline or glycerine. 

1 Finscn, Semaine Medicale, 1894, p. 302. 

' Boisse, Bulletin des Veterinaires de I'Arm^e, 18S7, p. 119. 



DERMATITIS. 229 

III. 

DERMATITIS. 

Eczematous dermatitis is met in all species of animals, presenting 
itself with peculiar localizations and modalities. It is most frequently 
seen in dogs. Generally speaking, it must have both local and internal 
treatment. 

For the local treatment one has the choice of numerous agents ; of 
these, however, some are more especially for certain forms or stages of 
the affection. Incipient eczema demands only the following treatment : 
Protect the skin from all causes of irritation ; cut the hair on the 
diseased surfaces and cover them two or three times a day with absorb- 
ing powders (starch, subnitrate of bismuth, oxide of zinc). On dogs, 
eczema patches have often a very disagreeable odor ; fancy and pet ani- 
mals may have these patches covered with essence of rose or benzine. 
At this stage of the disease, vaseline mixed with zinc oxide or boric acid 
can be used with advantage. For papular eczema, the treatment is the 
same. If the itching is severe, alcoholic watery lotions combined with 
a small quantity of carbolic acid (i per cent.) is to be prescribed. The 
use of absorbing powders is still the best local therapeutic measure for 
various modalities of moist eczema. Mixtures of powders of tannin and 
iodoform (10 to i), or of cresyl and boric acid (3-4 per cent.), give good 
results. In some cases, light cauterization with a solution of nitrate of 
silver (5-6 per cent) or nitric acid (i in 10) produces an excellent effect. 
If eczema is impetiginous, one must, by slight squeezing, press out the pus 
gathered under the crusts, wipe them well, and then cover them with 
antiseptic ointments. Scaly forms demand other treatment. Tar, cresyl, 
oil of cade, naphtol ointment, iodized glycerine, are to be recommended. 
Solutions of cresyl (2 per cent.), and of sulphate of iron or copper (i per 
cent.), are also used. The substances patronized lately (ichthyol, resorcin, 
anthrarobin) are not more active than the preceding. In all cases where 
eczematous disorders are exclusively due to mechanical causes, the local 
treatment is generally sufficient. But most commonly the general health 
of the patient is not good, so that an internal medication has to be started. 
Bicarbonate of soda, iodide of potassium, arsenious acid or Fowler solution 
are the principal agents. At times chronic eczema gives rise to a true 
warty dermatitis ; then the tegumentary vegetations must be amputated 
with the bistoury or scissors, and then cauterized with nitric acid or the 
actual cautery. We may mention the important influence that, in some 



230 VETERINARY SURGICAL THERAPEUTICS. 

species, especially dogs, hygiene, food and condition of life may produce 
upon the genesis and march of eczematous affections. 

On the surface where flexion takes place in the lower articulations of the 
extremities, one observes, often in horses, a dermatitis, the principal de- 
termining causes of which are the irritation produced on the skin by cold 
water and mud, manure, dust or the application to these surfaces of oint- 
ments made of lard or of vesicating preparations (blister on the fold of 
the hock or of the knee) ; this dermatitis is sometimes under the in- 
fluence of an eczematous diathesis. The skin tumefies, becomes warm, 
painful, and covered with vesicles, which ulcerate ; a serous, yellowish 
fluid exudes from the papillary layer, which, when the animal moves, 
cracks and forms fissures more or less deep, whose edges lose their hair 
and become indurated. The fluid secreted by these wounds dries on 
their surface, forming yellowish crusts. These cutaneous cracks (scratches) 
are not localized on the hollow of the fetlock only : they appear some- 
times behind the canon and alongside the tendons. 

Whatever be the seat of these lesions, ordinarily the leg is swollen, 
and complications of lymphangitis are frequent in recent scratches. 
The pain and the lameness, which are sometimes very great in nervous 
animals, are not so prominent in low-bred creatures. The transverse fis- 
sures of the knee {tnalandefs) and of the hock {sallendei-s) assume, in 
some cases, a scaly form, and are transformed into callous wounds. The 
fissures (scratches) of the canon and fetlock may terminate in the same 
way; sometimes they give rise to hypertrophic dermatitis. 

The prophylaxis of these affections consists in keeping the lower 
regions of the extremities thoroughly clean, in protecting the skin from 
long contact with dampness, mud or irritating liquids, and in not cover- 
ing the fold of the joints with vesicating preparations or greasy mixtures, 
which become rancid, irritate the skin and dry on its surface. " The 
practice of clipping the hair of the fetlock in winter and during the 
rainy season is the cause of many scratches. On this account, advice 
should always be given not to do this in winter on horses which in working 
are obliged to stand in mud or are kept outdoors a long time" (Weber).' 

When the hairs of the extremities are clipped, the legs ought to be 
washed with tepid water and well dried before the animal is returned 
to its stall. 

The curative treatment varies with the stages of the disease. A most 
varied assortment of drugs has been recommended : poultices, tincture of 
aloes, iodated glycerine, white lotions, egyptiacum and the Villate solution' 
all have their patrons. To all those agents we prefer careful disinfection 

' Weber, Bulletin de la Soc. Cent, de Med. Vet., 1889, p. 314. 



DERMATITIS. 231 

of the part, with as complete an immobilization of the diseased region 
as can be obtained. 

If the patient has to be kept at work, the skin should be washed morn- 
ing and evening with a tepid antiseptic solution and covered with a coat 
of creolinated or borated vaseline. Applications of lead or zinc are less 
efficacious. If the exudation is abundant, absorbing powders (starch, 
tannin, charcoal, oxide of zinc) are useful ; after the washing in the even- 
ing, a thin coat of these should be dusted over the diseased parts. 
When the animal is left to rest, antiseptic dressings bring on a rapid re- 
covery. The wounds are disinfected with a tepid cresyl bath; then, 
when thoroughly dried, they are dusted with iodoform, covered with 
iodoform vaseline and a wadding dressing, which should extend up the 
leg to reduce the movements of the lower joints as much as possible. 
Cagny disinfects the wound with chloride of zinc (i in 10) and applies 
a coat of Socin paste. 

When scratches have existed for some time, one must likewise employ 
antisepsis and immobilization. We may add that since this disease is 
sometimes related to eczema, an internal treatment is useful. Bicar- 
bonate of soda (20 to 30 grams a day), but, above all, arsenious acid in 
from 50 centigram to i gram doses, are the agents that give the best 
results. 

Recent malanders and sallenders require the same treatment. When 
they are old, they must be treated as callous wounds. 

Papitlar dermatitis of the legs of horses is a common affection in some 
countries, more frequent during extreme seasons than in intermediate 
periods. It is always localized on the extremities and rarely extends 
beyond the knee or the hock. 

The digital region, the fetlock and the canon are swollen and painful ; 
numerous papillae appear on the skin, and crusts are formed on their 
surface, which become loose and slough, leaving small hairless spots. 
We have seen them sometimes extending to the forearm and to the shank. 

This affection, the causes and nature of which are not well known, is 
without serious gravity and leaves no mark. It lasts only from three 
weeks to a month, and the affected animals can be kept at their work. 

A few tepid washes and daily cresyl lotions (2 per cent.) are always 
sufficient, even when the eruption is accompanied with quite large swell- 
ings. If fissures and cracks of the skin occur, wadding dressings are 
advantageous. 

CEdetnatous dertnatitis, also called warvi (edema, is commonly observed 
during summer in the regions where the skin is exposed to the irritation 
of the harness, more especially the withers, where it is produced by the 
saddle. Let the harness fitting badly shave the skin, compress it or bruise 



232 VETERINARY SURGICAL THERAPEUTICS. 

it, or let the tegument, moist with perspiration, adhere to the harness, 
or loosen with it, lacerating the subcutaneous connective tissue, then a 
phlegmasia involving the skin and that tissue will develop, the region will 
become swollen, hot and more or less painful. 

All the treatment to be given is to suppress the cause of the disease, and 
if the epidermis is still intact, to apply cold or astringent lotions (white or 
alum solution). After a few days resolution is complete. If it takes place 
slowly, massage in the direction of the hair will stimulate it. When the 
skin is excoriated, antiseptic lotions and applications of borated, carbol- 
ated or iodoformed vaseline are used. In the rare cases of oedematous 
dermatitis, severe from the start and ending with the formation of a sub- 
cutaneous abscess, this must be opened early and treated as ordinary 
suppurating collections are. (See Abscess.) 

The chronic phlegmonous dermatitis, which seems peculiar to dogs, is 
ordinarily localized on small surfaces. It is observed most commonly on 
the lips, the sheath, the elbows, the hock or the digits. Danish dogs, 
large dogs and short-haired breeds are more exposed to it than small 
dogs. 

It is characterized at first by a tumefaction of the skin, on which the 
hair falls off ; it suppurates and shows an abscess very similar to that of 
follicular mange. While in this latter, however, most of the small purulent 
centers are whitish, in simple phlegmonous dermatitis all have a bluish-red 
tint, and the thin cutaneous layer which forms their external wall is shiny 
and has contents of a bloody appearance. These abscesses are fol- 
lowed by fistulous tracts which give escape to pus mixed with blood. 

Generally the disease progresses slowly. It may remain stationary for 
months ; in some instances it covers extensive surfaces and is complicated 
with fatal results. We have observed a dog in which the disease started at 
the sheath, extended to the groin and the right thigh, and gave rise to fatal 
peritonitis. Cultures of the pus, taken from the abscesses of the sheath 
and from the thigh, as well as that of the peritoneal effusion, produced 
colonies of staphylococci (staphylococcus pyogenes albiis 2>xi^ aureus). In 
some cases where the lesions were circumscribed, we have isolated the 
same micro-organisms. 

This phlegmonous dermatitis is tenacious and obstinate to treatment. 
We have used against it numerous agents without much success. Dis- 
infection of the skin with antiseptic lotions, puncture of the purulent 
centers, cauterization of their walls with chloride of zinc or nitrate of silver 
and applications of tincture of iodine will sometimes succeed. When the 
patches are small and few, excision and an iodoform dressing are the 
preferable treatment. 



DERMATITIS. 233 

GatJgrenous derma tifis has a complex etiology. It is frequently the 
termination of severe cutaneous, traumatic, toxic or infectious phlegmasias 
which have not been controlled. Solar erythema, feeding on damaged 
food altered with fungi, may promote it (Friedberger and Frohner). 
Gangrenous dermatitis of extremities — cutaneous quittor — so frequent in 
horses during winter, is due especially to the action of cold (freezing) mud 
on the skin.i Irritating liquids (urine), caustics, traumatisms and especi- 
ally blows that animals give to themselves may bring on the same result. 
The swelling of the hind extremities predispose to this affection (Chenier), 
As soon as the integrity of the skin is destroyed, the action of the bacteria, 
added to that of the other pathogenous causes, increases the inflammatory 
process and brings on gangrene. 

The diffused tumefaction and soreness of the region, the bristling of the 
hair, the oozing of the skin, the dark coloration of the diseased parts 
when free from pigment, all indicate the severity of the phlegmasia and 
the threatening gangrene. In cases of cutaneous quittor, the inferior part 
of the leg is tumefied more or less and the swelling extends at times above 
the knee or the hock. The sensibility and the lameness are more or less 
pronounced according to the degree of inflammation. On the inflamed 
part there soon appear " small elevations which spread open and allow 
the sloughing of necrosed pieces mixed with pus and blood " (Barthe), 
or moist cutaneous patches partly mortified or already gangrenous. It is 
not rare to detect in the centers of these patches deep fluctuation, indicat- 
ing the existence of subcutaneous suppuration. 

The preventive treatment depends upon the etiology. At times the 
feed has to be changed (solar erythema), or again, the numerous causes 
of irritation upon the skin must be prevented or attenuated. For cut- 
aneous quittor especially, the hair of the lower parts of the extremities 
should not be dressed (clipped) during cold or rainy weather (Weber), 
and the legs should be carefully attended to (tepid washing, drying, appli- 
cation of an isolating, greasy substance, in cases of work in freezing mud). 
Swollen, elephantiasic legs, whose tissues are predisposed to necrosis, re- 
quire special attention. (See Frost-bites.) 

Against incipient dermatitis, the means indicated in the chapter on 
Inflammation should be used. Friedberger and Frohner recommend an 
ointment of lead and tannin, or antiseptic vaselines. We generally use 
antiseptic baths twice a day, with bandages wet in the same fluid. Scari- 

' Several years ago we saw a true epizooty of this affection among the 
horses of the railroad companies in New York, caused by the free use of salt to 
melt the snow in the streets. We have seen animals in which the entire 
skin had sloughed on the whole inside of the legs from the feet up to the 
groin J others where the entire abdominal wall was bare of skin. 



234 VETERINARY SURGICAL THERAPEUTICS. 

fications are sometimes useful. If fluctuation is present, early opening is 
to be advised, as by it and antisepsis, complications and gangrene at 
times are avoided. 

If mortification already exists, the treatment must be that of moist 
gangrene. The wound resulting from the cutaneous slough should be care- 
fully disinfected with baths of tepid water and covered with an antiseptic 
dressing. We prefer iodoformed, cresylated or carbolated vaseline to old 
ointments. Before antisepsis, when cutaneous quittor was treated with 
greasy substances or poultices, complications were frequent ; a serious 
lymphangitis often followed ; or a tendon, a synovial sac or one of the 
fibro cartilages of the foot would become involved. If modern therapeutics 
has not removed all those serious accidents, their frequency is at least con- 
siderably reduced. 

Contagious pustular dermatitis of horses, generally limited to regions 
upon which the harness or blankets rest, may exceptionally extend to the 
whole surface of the body. It is characterized by small isolated or col- 
lected pustules varying from the size of a pea to that of a bean. After 
a few days these pustules burst, their contents dry up and form yellowish 
scabs, which soon drop off. In the light forms recovery is complete in two 
or three weeks ; in severe cases the very numerous pustules are followed 
by ulcerations at various depths ; lymphangitis makes its appearance and 
the surrounding glands sometimes enlarge and suppurate. Purulent cen- 
ters may also develop in the affected region. All these are not very 
painful, the itching is slight or even absent, and the general condition is 
not at all altered. 

Contagious and inoculable, produced by a specific bacillus, this der- 
matitis is transmitted by harness, blankets and tools for cleaning. The 
period of incubation varies between six and fifteen days. 

Isolation of the sick, disinfection with boiling water or corrosive subli- 
mate solution of harness, blankets, stables, etc., are the two principal 
requirements for prophylactic treatment. 

All care should be taken to avoid the dissemination of the bacillus upon 
the skin of regions which surround the acneic regions. In the beginning 
lotions of corrosive sublimate (i in looo), cresyl (3 per cent.), sulphate 
of copper or zinc (2 per cent.) (Trasbot) should be applied. When the 
crusts are formed, they can be scraped off," removed, and applications 
made of vaseline mixed with carbolic acid, corrosive sublimate or iodoform. 

Verrucous dermatitis of the horse, the morbid affection, commonly 
called grease, consists essentially of a chronic, exudative and hypertrophic 
inflammation of the skin of the inferior regions of the extremities. It 
was very common in past times, but with the progress of hygiene it has 
become more and more rare. As in the past, it is principally observed OH 



DERMATITIS. 235 

the hind legs of low-bred horses having long hair and working in the 
mud and dampness. The pathogenous action of dampness, manure and 
irritating fluids is no longer discussed. 

Between this affection and chronic verrucous pododermatitis (canker 
of the foot) there are close relations, and they seem to differ only in 
their localization. What is known of its nature, however, is sufficient to 
suggest a strong and sure treatment. While some authors consider it as 
an affection entirely local, and many as a common eczematous manifesta- 
tion, it is related to a general morbid condition (lymphatism, arthritism). 
The frequency of the disease on several extremities together, and the re- 
sistance it offers to the treatments used to prevent it, are serious argu- 
ments in support of this last opinion. 

The preventive treatment rests altogether on the etiology : avoid pro- 
longed action on the skin of the legs of mud or irritating fluids ; dress at 
once and with care all wounds, fissures, scratches and cutaneous phleg- 
masias of those regions. 

As soon as the disease is developed, a local active treatment is re- 
quired. To name all the means recommended would be tedious. Let us 
consider only the principal ones. 

Although the acute phenomena and lameness are often missing, there 
are cases in which the inflammation of the skin is very pronounced. This 
was overcome in the past by bleeding, emollient poultices, a seton on the 
thigh or on the chest ; now it must be treated with tepid antiseptic lotions 
or baths. Twice a day a lukewarm soaking of cresyl (2-3 per cent.) or 
of sulphate of copper (3-4 per cent.) should be given. Between these, 
the regions should be covered with bandages moist with a similar mix- 
ture ; soon the inflammation will subside, the region becomes cleaner and 
the secretion diminishes. Apply astringents or slight caustics. Many prac- 
titioners prefer the lotions or the dressings of Villate solution, or of sulphate 
of copper (4-6 per cent.). Moller recommends the mixture of sulphuric 
acid and alcohol (i in 10-20) applied as dressings. Prange's mixture (alum 
125, sulphate of zinc 125, arsenious acid 10, sulphuric acid 5, water 1000), 
the caustic liquid of Veret (sulphate of copper 10, sulphuric acid 12, 
vinegar 78), that of Delabere-Blaine (corrosive sublimate 30, 22° alcohol 
30, water i liter), have their patrons. All may be used with advantage if 
antiseptics have been applied previously. 

With the precaution of keeping the animal from the continued action 
of water or mud, moderate work is advantageous. 

After recovery, relapses are avoided by good hygiene, cleanliness of the 
places where animals are kept, attention to the clean condition of the ex- 
tremities, and by the administration now and then of internal treatment. 

Many foreign authors continue to consider as a special dermatitis the 



236 VETERINARY SURGICAL THERAPEUTICS. 

various cutaneous localizations of horse-pox. The various forms of this af- 
fection have been known since the observations of Lafosse and Bouley. At 
times the eruption is generalized, and pustules in varying numbers exist on 
the skin, which are isolated in some regions, agglomerated in others, and 
sometimes localized in one region, or again in several. Frequently it oc- 
curs on the inferior parts of the legs, giving rise to that form of phlegmasia 
which, towards the end of the last and beginning of the present century, 
English farriers caWed grease, and which Jenner has named "shore-heels." 
Extending over large surfaces, it resembles ae//fe grease {eaux-aux-jatnbes 
aigiies) ; sometimes it is added to some recent or old lesion, to a wound 
of operation, to necrosis of the scutiform cartilage or of the tendons, and 
may be supposed to be an erysipelatous outbreak ; again, in other cases 
it is confluent on the inferior parts of the head, on the skin of the lips, 
of nostrils, on the pituitary membrane, and is accompanied with lym- 
phangitis or adenitis, and these present a clinical aspect which at first 
may make one believe it farcy or glanders ; it is also that which, when 
located upon the buccal mucous membrane, constitutes the disease de- 
scribed under the name of contagious pustular stomatitis. 

Lafosse and Bouley have shown, by inoculation of cattle, the true nature 
of this eruptive affection with so many manifestations : the fluid of the 
pustules, inserted in the skin of heifers, has produced vaccine. 

The cutaneous phlegmasias produced by horse pox may affect lymphatics 
in various degrees, but their typical progress, their peculiar characteristics 
and their short duration render the diagnosis easy. Even on the fetlock 
or the coronet it is easy to differentiate the eruption of horse- pox from 
gangrenous dermatitis (cutaneous quittor) from scratches or from " grease." 

Since the disease is very contagious, prophylactic measures are im- 
portant. Avoid the transportation of the virulent serosity by means of 
instruments used for cleaning the animals. The cyclic evolution of the 
eruption, and in the generality of cases its benignity, disprove active 
interference. Ordinarily it is sufficient to watch the progress of the disease 
and attend to the complications that may appear, such as lymphangitis, 
adenitis, etc. The application of absorbing or antiseptic powders at the 
stage of exudation and in the cases of acute inflammation of the skin of 
the lower parts of the extremities, rest, carbolic or cresyl warm baths 
and wadded dressing constitute all required therapeutics. 

Moller advises dusting the diseased parts with a mixture of tannin 
and iodoform, or covering them with an ointment of paraffin and red 
oxide of mercury with a wadded dressing, which is left for a variable length 
of time, according to the amount of suppuration. 



ELEPHANTIASIS. 2^f 

III. 

ELEPHANTIASIS. 

Elephantiasis is not a simple morbid entity, but a lesion common to 
several affections. In animals we do not observe the enzootic form that 
"human" physicians find in filariosis. The form which attacks horses 
corresponds to that known in man as ArahiaJi elephantiasis. I'he disturb- 
ances of the venous or lymphatic circulation, or of both, are the ordinary 
causes. 

The onset of the disease varies : at times it occurs immediately after 
an attack of acute lymphangitis whose resolution has been incomplete ; 
at others it succeeds the local swellings accompanying suppurative lesions 
of the skin (furuncles, scratches), or at others seems to come at once 
without any apparent lesion of a venous or lymphatic nature, and develops 
slowly. In all cases the process consists in a " hypertrophical fibrous der- 
matitis with sclerosis of the skin and connective tissue." 

In horses, elephantiasis is especially common to the hind legs, localized 
on one or affecting both ; it is also seen on the fore legs, or on other 
regions, principally the sheath or the lips. 

The diseased parts are the seat of a chronic phlegmasia which will 
not disappear. Besides the acute manifestations that may appear, the 
swelling is evenly hard and painless ; it increases by rest and diminishes 
by exercise. In the hind legs, the hypertrophy is sometimes limited to 
the fetlock and the phalanges ; often it extends to the fetlock, and in some 
cases goes higher, to the shank. Ordinarily, the swelling is uniform, the 
leg hypertrophied as a "regular cylinder," the skin is tense, hard, 
smooth, without inflammatory spots or fissures or epidermic abrasion. 
Inflammatory manifestations may occur and abscesses develop in the thick- 
ness of the dermis. When the affection is old and the leg enlarged, 
projecting ridges are seen on the hock, fetlock and coronet. The affected 
leg may assume considerable size and weight ; in a case of elephantiasis 
of the hind leg in a horse, Siedamyrotzky has seen the hock measuring 
75 centimeters around and the fetlock 65. Burmeister has dissected one 
leg which was so large that the subtarsal region weighed 50 kilos (100 
pounds). 

Wounds of the extremities, scratches and lymphangitis are rarely 
complicated with elephantiasis when a wadded dressing immobilizes the 
region and prevents the soiling of the wounds and the chronic inflamma- 
Uqu of the skm and connective tissue. 



^3S VETERINARY SURGICAL THERAPEUTICS. 

The disease once established has no tendency towards resolution : all 
means used against it fail. It is said to be the more serious and obstinate 
the more rapidly it develops. Whatever its mode of development, we have 
almost always found it equally tenacious. 

Ointments made of lard, which irritate the skin and promote the drop- 
ping of the hair, should be avoided. Alteratives, blisters, actual cauteriza- 
tion, not only are of no benefit, but their action is most often injurious ; in 
the few cases where we have tried them they have invariably produced an 
increased activity of the hypertrophy. Scarifications are followed by the 
escape of a little quantity of fluid ; the sclerosis is greater than the oedema. 
Disinfection of the skin and keeping it in perfect cleanliness, slight mas- 
sage and compression constitute the whole treatment. Abuse of baths 
and douches is injurious. Compression is made with flannel bandages or 
elastic rollers : it should be intermittent and tightened to a moderate de- 
gree ; if it is too loose it will produce no effect ; too tight, it may bring 
on cutaneous gangrene. With some patients, the latter can be produced 
very readily ; we have several times seen sloughs made by a rubber band 
moderately tightened. To resume, one should advise moderate work, 
medium massage and the application, for the night, of a rubber bandage 
rolled from below upwards round the leg and wrapped in a pad of oakum 
to regulate the pressure : the leg should be kept strictly clean, frequently 
washed with tepid water and dried. Light elastic pressure should not 
continue more than ten or twelve hours. 

Lymphangitic manifestations and abscesses that sometimes occur, de- 
mand other means of treatment. (See Diseases of the Lymphatics and 
Abscesses.) 

Under the name of elephantiasis has been described an affection of 
cattle very different from that of the same name in the horse. It begins 
with dulness, inappetency, febrile symptoms ; the skin becomes tumefied 
on the dewlap, under the abdomen and on the legs, then the knee and 
hock. The nose, ears and eyelids are soon oedematous ; ulcerations ap- 
pear sometimes in the mouth and in the nose, accompanied with a flow 
of thick and fetid saliva or a more or less abundant nasal discharge. 
Soon fissures appear on the diseased parts, the skin dries up, the hair falls 
off. Some animals die ; but generally the wounds heal and the animal 
recovers, but remains thin. The thickened skin is covered with fur- 
furaceous scales ; in some cases the hair does not grow any more. Zundel 
considers this as a special form of contagious catarrh. For Cad^ac, it is a 
variety of anasarca. 

Cruzel has for a long time tried numerous pharmaceutical products. 
Arterial bleeding, however, nitrated drinks, but especially frictions with 
sj^Jirits of turpentine, repeated several times a day on all tumefied parts of 



ACNE. ^30 

the skin, seem to be the most advantageous treatment at the beginning, 
and when there are no cracks on the skin. Cadt^ac recommends the treat- 
ment used in anasarca : at the very outset, before the appearance of the 
swellings, bleeding gives the best results ; later, the sulphate of soda, 
alcohol, wine, nitrate of potash, scarifications and vapor baths. Irritating 
frictions (charges, ammoniacal liniment, spirits of turpentine) made on the 
swellings might be used. 

If gangrene occurs, the sloughing of the eschars is to be assisted, and 
the wounds following to be dressed antiseptically 



V. 

ACNE. 

The papulo-pustular eruptions due to the inflammation of sebaceous 
glands of a non-specific nature are met in subjects of the various domestic 
species, but more frequently in horses and dogs. Produced by multiple 
causes, they seem to be especially the result of mechanical irritations to 
which the pilo-sebaceous follicles are particularly sensitive. 

In horses recently clipped, it is. common to observe, on the regions 
supporting the harness, confluent patches of acne. Short, rough hair 
transmits the pressure to the hairy bulbs, act as irritating thorns, and thus 
promote a papular or pustular inflammation. On the superior border of 
the neck, where the collar rests, the hair of the mane, cut very short, 
may also irritate the pilo-sebaceous follicles and bring on an eruption 
of acne, which may be complicated with extremely painful cores. (See 
Cores.) In dogs, acne may be seen in the most different regions ; some- 
times, in serious cases, it becomes generalized. It is rare in ruminants. 

When the cause of acne is known, the first rule of treatment is to relieve 
or remove it. On horses, soft pads should be placed between the har- 
ness and the diseased part. Since dirt keeps up the disease and pro- 
motes its spreading, repeated tepid antiseptic washings should be given, 
and after careful drying the parts should be covered with glycerine, car- 
bolated or borated vaseline. When the disease is recent, these means 
are sufficient. On old cases, when the skin is indurated, mercurial oint- 
ment can be advantageously used. 

In the case of dogs, for recent acne, salicylic lanolin (salicylic acid 20, 
lanolin 80-100) is better; but for old acne, cresyled boric acid (creoline 
I, boric acid 40). Before their application, the purulent pimples should 
be opened and the diseased surfaces well cleaned. 



240 VETERINARY SURGICAL THERAPEUTICS. 

VI. 

FURUNCLE— ANTHRAX. 

Circumscribed infectious inflammations of tiie skin, ending in suppura- 
tion and the formation of sloughing cores, are somewhat common in 
animals. In furuncle, the inflammation is limited to small cutaneous 
spots : the tumor resulting from it is small, conical and very painful ; it 
suppurates and is followed by the slough of its necrosed center. Furun- 
culosis is observed in all domestic animals. Zundel has observed it in 
horses which, having been accustomed to good care and little work, have 
been called to heavy service ; in army reformed horses, in animals which 
after working for grain and seed dealers have been disposed of, and also 
in reduced and exhausted animals. We have often observed it on various 
parts of a dog, and on horses on the lower parts of the hind legs. 

Ordinary anthrax is but a voluminous, diffuse furuncle, extending to the 
subcutaneous connective tissue, or an inflammatory tumor formed by con- 
fluent furuncles. Like the generality of human surgeons and of foreign 
veterinarians, we have no hesitation, notwithstanding the etymology, to 
apply this word to lesions which have nothing in common with anthrax 
(charbon). 

Bacteriology has shown that furuncle and anthrax are promoted in man 
by the same micro-organism, the staphylococcus pyogenes aureus. In the 
furuncle " the infectious organism enters by the opening of a pilo-sebace- 
ous follicle ... if several neighboring each other are affected the furuncle 
becomes an anthrax " (Broca). 

Basilicon ointment, mercurial frictions, laurel ointment and poultices 
must be left aside. The disinfection of the region carefully made, first 
with soap and water, then with tepid antiseptic solutions (corrosive 
sublimate, carbolic acid or cresyl), and above all, lotions or atomizing 
vapors of these solutions and also warm compresses (50°) covered with an 
impermeable protection, constitutes the best treatment of the furuncle. 
These antiseptic compresses have all the advantages of poultices and 
none of their inconveniences. With them pain subsides, redness dimin- 
ishes and the lesion is circumscribed. For inferior regions of the legs 
antiseptic baths are to be particularly recommended ; they can be given 
two or three times a day and their action completed with compresses. 

In the case of anthrax the preceding form of treatment may be followed 
alone or preceded by the early incision of the tumor, according to the 
seriousness of the lesions. If purulent collections develop in the neighbor- 



SEBACEOUS CYSTS. 24I 

hood they should be opened as early as possible and properly dressed. 
Free incision and drainage are sometimes useful. Thermo-cautery will 
arrest the hemorrhage and prevent auto-inoculations. (See Adsress.) 
Sometimes a general treatment is required. Purgatives and arsenic 
seem of little advantage. Cresyl and naphtol are good in some cases. 

VII. 

SEBACEOUS CYSTS. 

These are seen with varying frequency in all domestic animals and on 
any region of the body. In horses they are most frequent on the nose, 
in the false nostril, the lips, the ear and the sheath. Their origin is still 
in doubt ; the majority of authors say that they are due to the accumula- 
tion in sebaceous glands of the product of their secretion ; but one may 
exceptionally observe them on the buccal mucous membrane and on that 
of the lips, where there are no sebaceous glands : perhaps these are cases 
of epidermic occlusions. The first cause is the obliteration of the orifice 
of the duct common to the hair and the sebaceous follicles, produced 
either by dried epidermic scales or by inilammation. The size varies 
from that of a hazel-nut to a large nut. They are round, perhaps a little 
flattened, depressed in the center, well defined in their surroundings, 
painless, of various consistency, most commonly puffy, more or less resis- 
tent, at times fluctuating or again of an uneven consistency, very hard 
in some places, very soft in others. The contents, formed of epidermic 
cells and greasy substances, vary in their aspect according to the pro- 
portion of the constituent elements ; generally it is a caseous mass, at times 
a solid substance analogous to solidified fat (steatomatous cyst), at others 
it is a matter looking like honey (melicerous cyst). 

If the positive diagnosis in some cases is quite difficult, it is of 
secondary importance : the sebaceous cyst cannot be mistaken only for 
afifections requiring the same mode of treatment — puncture or removal. 

Simple puncture is always insufficient ; it permits the evacuation of the 
contents, but the wound heals rapidly and the growth returns. Repeated 
punctures followed by irritating injections (tincture of iodine 1-3, chloride 
of zinc i-io) are often sufficient to obtain recovery. We succeeded 
with this treatment in the case of two large cysts of the false nostril. 
Potential caustics used after the evacuation of the contents are also 
somewhat successful. Ablation is the best way, however. After incision 
of the skin the mass is enucleated with the bistoury or the director, care- 
fully avoiding the opening of the sac. With antiseptic care the cicatriza- 
tion of the wound is rapidly obtained. 

16 



242 VETERINARY SURGICAL THERAPEUTICS, 



VIII. 
CUTANEOUS HORNS. 

Abnormal projections are sometimes observed on animals in various 
regions, but more particularly on the head. They are hard, formed of 
keratinized epidermic cells, and known as cutaneous horns. Generalized 
horns have, so far, been observed only in men. In animals — horses, cattle, 
sheep, dogs and cats — only cases of single horns have been recorded. Al- 
though their chosen spot is the head, they also grow on the back, flank, 
abdomen, and on the legs. They are of various lengths and sizes, straight 
or curved, smooth or rough. In parts exposed to repeated rubbings neo- 
formations similar to them may be observed. (See Hygroma of the Knee.) 
Some of these productions fall ofif after several months, but are soon 
replaced by others. The others remain permanently. 

While in mammifera cutaneous horns are the expression of a horny 
hypersecretion due to causes which cannot be determined in some species 
of birds, especially in parrots, it is common to find on the cheeks or 
other regions of the head, on the buccal mucous membrane, on the 
trunk and the extremities, horny productions of a tuberculous nature. 
Since attention has been drawn to these singular tuberculous neoformations 
we have met with several cases. In these the bacillus of Koch promotes 
the keratogenesis. Krampf has reported the case of a phthisical parrot 
which had on the right cheek a horn measuring two centimeters at its 
base and five centimeters in length. (See Fig. 56.) Megnin has recently 
reported a similar case. 

The only efficacious treatment is extirpation. If cutaneous horns are 
only sawed off they grow again. They must be removed entirely, and the 
portions of perverted skin where they are must be excised, or, as recom- 
mended by some, destroyed with caustics. The use of the bistoury is 
better. (For the treatment of cutaneous horns of the parrot, see Tuber- 
culosis.) 

The ichtyosis observed in calves by Numann, Gurlt, Pangoue, Goubaux, 
consists of a general hypertrophy of the epidermis. The skin resembles 
that of an alligator. There is no treatment for such an affection. All 
the calves which were affected with it died a few days after birth. 



TUMORS. 243 

IX. 

TUMORS. 

Cutaneous papillomata, common to animals, are more frequent in 
horses and cattle than in other species. They are observed on all regions, 
but those which are most affected are the head, the inferior face of the 
trunk, the genital organs, and the internal face of the legs. In horses, 
donkeys and mules, papillomata sometimes exist in great number, so 
that they can be counted by hundreds over the surface of the body. On 
a cow treated by Lehnert their weight amounted to twenty kilos. They 
Vary in size from that of a pea to that of a nut, and sometimes form 
masses as big as the fist. 

Although these tumors are not serious in themselves, they are much 
exposed to traumatic action, bleed easily, become inflamed and secrete a 
purulent fluid which dries on their surface or putrefies and has a fetid odor. 
They may also interfere with the motions of the animal or with other 
functions, and when they exist in great numbers they soon have an evil 
effect on the general condition. 

The considerable number of warts which sometimes exists on one 
animal has suggested the admission of a " papillomatous diathesis." 
Hertwig has claimed that these productions were hereditary. It has been 
supposed that secondary tumors sometimes develop in parts soiled by the 
blood of a primitive growth. Their contagious nature has been admitted 
for a long time by outsiders. Majocci, Cornil, and Babes have found in 
them a special parasite — the bacterium poi-ri. 

In young animals it is not rare to see warts disappear spontaneously, 
even when they exist on comparatively wide surfaces. The same termin- 
ation of these may be observed at all ages. Liibke has related the case of 
a thirteen-year-old horse covered with warts of all sizes, which dropped 
off without any treatment, leaving wounds which cicatrized regularly. But 
these spontaneous recoveries are exceptional, and when warts are numer- 
ous, voluminous, or when they simply interfere with functions, they de- 
mand an active treatment. The internal therapeutics (calcinated magne- 
sia, arsenious acid, mercurials) succeed only with benign ephemeral forms 
or with those whose time of recovery has arrived. If magnesia given in 
doses of 0.50 centigrams to two grams a day seems to bring on the slough 
of the labial warts of the dog, we know that they disappear spontaneously ; 
and the case of Liibke, to which many others could be added, shows that 
the result will be the same for cutaneous warts wherever they may grow. 

The only efficacious treatment of permanent warts is their destruction 



244 VETERINARY SURGICAL THERAPEUTICS. 

with caustics, ligature or the bistoury. Sulphuric, nitric, muriatic, acetic 
or chromic acid can be used. After scraping the superficial layer which 
covers them the caustic fluid is applied on the top of the growth with a 
glass or wooden rod, being careful not to touch beyond the outlines of 
the affection. The cauterized layer dries off and sloughs after a few days. 
The cauterization may be repeated several times. Arsenious acid and 
several arsenical products, used as powders, dusted on the surface of 
the warts, brings on mortification and sloughing. Boudeaud has recom- 
mended repeated applications of the following preparations : 



Grams. 

Arsenious acid 5 

Sabine powder \ - - 

Pulverized gum-arabic / 

Simple cerate 36 

Corrosive sublimate i 

Resinated collodion 30 

In the case of large animals, where the treatment must be quick and 
economical, the best way is to remove these tumors with the ecraseur, 
the bistoury, or to burn their bases with the red-hot iron. In dogs, silk 
ligature is preferred, or slight and repeated cauterizations until they are 
entirely removed. 

Multiple fibroinas, adenomas, osteomas (Leblanc), neurojuas and the 
other neoplastic species are more rare. If they are numerous, interfer- 
ence is difficult and often useless. When they are isolated the treatment 
consists in the free removal of the neoplasia. The adenoma of Lienaux 
was not adherent to the skin : its extirpation was easy. Bony plates of the 
subcutaneous connective tissue (Liard, Laquerriere) are removed almost 
always successfully. 

Epitheliomas and caticroids are ordinarily met in the neighborhood of 
natural openings, most commonly the lips. They are peculiarly common 
on old dogs. Their clinical characteristics are well known : at first a small, 
hard, invading tumor ; later, painless or almost painless ulceration, sharply 
outlined at the top, dry at the base, grayish in color, surrounded with in- 
durations and accompanied with specific lymphangitis and adenitis. At 
the beginning recovery has sometimes been obtained with arsenical 
caustics. Chlorate of potassium in powder or saturated solution and 
methylene blue have succeeded in some cases. But total extirpation of 
the neoplastic center is still the chosen treatment. It is important to 
operate early, before the appearance of the adenopathies. (See Treatment 
of Tumors in General.) 

Cutaneous and hypodermic sarcomas exist ordinarily with visceral growths 
of the same nature, more or less generalized. 



TUMORS. 245 

i' *■. 

PARASITIC AFFECTIONS. 

We shall say nothing of the affections produced by insects, acari or 
fungi which live on the surface of the skin. The genera sarcophagus 
and lucilla give larvae which live as parasites upon wounds of men and of 
animals ; Megnin has found on them the sa^rophagus magnificent. In 
Holland the developed larvae of lucilla have been observed on sheep. In 
tropical countries the larvae of some meat-flies deposited on the umbilicus 
of young calves produce fatal inflammations (Friedberger and Frohner). 
Cleanliness and washing with antiseptic solutions are sufficient to per- 
fect a cure. The ochromycis anthropophagus, or fly of Cayor, gives larvae 
which develop in the subcutaneous connective tissue of man and some 
animals (dogs, cats, goats). The small tumors that they produce disap- 
pear rapidly after the exit of the larvae, which can be assisted by a free 
incision. The connective tissue of pigeons contains sometimes a larvae 
{hypodectes columbaruni) which produces slight inflammation. 

During the summer season the hxpodenna hovis lays eggs on the 
surface of the skin of cattle, which produce larvae that perforate the skin 
and develop in the subcutaneous tissue. In the following spring tumors 
in various numbers are observed on the body of the animal, about the 
size of a nut and resembling cold abscesses. These are due to the chronic 
inflammation caused by the presence of the parasites. The skin ulcerates 
and presents little suppurating wounds. The trouble can be prevented 
by soaking the skin in appropriate solutions (oak-leaf decoctions, weak 
solutions of tobacco, aloes, asafetida). It has been recommended not to 
take the animal to pasture before ten o'clock in the morning during the 
warm season (from April to August). The larvae that are thrown out 
before that hour fall on the floor of the stable and die, while they would 
develop easily in pastures. The larvae can be killed in their pouch by in- 
jections of benzine, turpentine, salt water, tar, or they can be cauterized 
with a red-hot stylet ; but the best treatment is to freely incise them, taking 
hold of the larvae with forceps or extracting them by pressure. Simple 
cleanliness is sufficient to insure recovery. 

The subcutaneous tissue of horses and donkeys gives asylum to larvae 
which resemble much those of the hypoderma bovis. These demand the 
same preventive and curative treatment. 

Filaria may produce in some animals cutaneous helminthiasis. Horses 
of Oriental breeds are subject to a special affection characterized by the 
eruption of " hemorrhagic pimples." During the warm season one may 
observe in numerous regions, especially the withers, neck, back and loins, 
pimples in various numbers and sizes, from that of a hazel-nut to a large 
put. First wdematoug on their periphery, slightly ecchymotic in the 



246 VETERINARY SURGICAL THERAPEUTICS. 

center, they soon ulcerate and give escape to blood which sticks to the 
hair ; these hemorrhages are produced by filaria, whose last habitat was 
the subcutaneous connective tissue {^filaria multipapillosa or hcemorrha- 
gica). Successive eruptions are observed during the warm season ; the 
disease generally disappears with the cold weather, but it may return the 
following year. Though Brunswig and Liautard have seen animals die 
from anaemia following these hemorrhages, death is the exception. The 
rapid cicatrization of the ulcerated pimple is the rule ; sometimes sup- 
puration occurs (Lamy). That which renders the affection serious is the 
impossibility of using the animals, some remaining unfit to work for months 
notwithstanding all forms of treatment (Drouilly). 

The therapeutics is simple. Sustain the patients on good food, and 
do not use them when the presence of the pimples interferes with the 
wearing of harness. Wash the wounds with antiseptic solutions. When 
there is suppuration Lamy cauterizes with the hot iron. If the pimple 
is observed at the moment of the spontaneous opening the filaria can be 
extracted and its entrance in the cellular tissue prevented. 

The larvse of Xh.e filaria irritans are often the cause of serious com- 
plications of wounds. (See Summer Wounds.^ 

We may also mention as a parasitic disease of the skin " a cutaneous 
affection which often attacks hens, turkeys, especially pigeons, and some- 
times geese (Csokor), and to which the name has been given of cutaneous 
psorospermosis, epithelioina co7itagiosu7n or moUuscum contagiosi/m.''' It 
is characterized by the production of nodosities, warts on the head, which 
can, however, in pigeons cover the whole body. 

Cauterization or ablation of the tumors is the most efficacious treat- 
ment. Disinfection and isolation are to be recommended. 

The connective tissue sometimes lodges psorosperms {Imlbianeal gigaii- 
tes). ]\Iet with in cattle, sheep, goats or swine, they do not seem to 
produce any trouble and offer no interest from a surgical point of view. 

Hydatic cysts give rise sometimes to external growths in the cellular 
tissue. Raymond treated a horse which had a tumor on the costal region 
which healed after seven years, having thrown out a large number of 
echinococci. Villate, Cohn, Broquet and Megnin have reported similar 
cases, always in horses. These hydatic cysts at times undergo purulent 
transformation. In an abscess of the temporal fossa Kirkman found a 
handful of hydatids. At the post-mortem examination of a horse killed 
on account of its bad condition, Ranvier and Dehors found a large ab- 
scess extending from the left kidney to the superior border of the ilium ; 
the pus contained a hundred or more echinococci. Simple incision and 
puncture followed by iodine injection are insufficient in the treatment 



TUMORS. 247 

of hydatic cysts. Total extirpation is tlie best way. When impracticable, 
remove all that can be taken off, use the curette on the rest. 

Rivolta, Bassi, Gotti, Perroncito, and Vigezzi have described, in the 
case of horses, donkeys and dogs, fibrous tumors of the connective 
tissue due to spiiopterus 7-eticulus. They are frequent on the anterior leg, 
at times compress tendons or nerves and give rise to lameness. Tschu- 
lowski has shown that among horses which are the carriers of the spiropieriis 
reticulus the embryos are ordinarily found in lymphatic vessels, the peri- 
vascular connective tissue and the articular and tendinous synovial mem- 
branes of the extremities. (See Raillet, Traite de Zoologie inedicale ; and 
Neumann, Treatise on Parasitic Affections of Domestic Animals.^ 

The extirpation of the tumors is the only proper treatment. 



CHAPTER II. 

SEROUS BURSiE. 

I. 
TRAUMATIC LESIONS. 

Wounds of serous bursse do not essentially differ from those of the 
cellular tissue, except by the flow of a fluid of synovial aspect, which might 
make one fancy an articular lesion. The clinical characteristics combined 
with the anatomical data allow one in all cases to recognize the nature 
of the disease. The gravity of the trauma depends on its extent, its aseptic 
or infectious character, and the properties of the pathogenous agents de- 
posited in it. 

The treatment must be antiseptic : clipping of the hair around it, 
irrigation with a strong disinfecting solution, in some cases sutures and a 
closing dressing. If inflammatory manifestations occur, free opening and 
treatment of abscesses are required. 

Bruises of serous bursse have a varied progress. A violent blow may 
rupture their walls and bring on the escape of the fluid they contain 
into the surrounding connective tissue. Sometimes extravasation of 
blood takes place in the cavity of the bursse, or an acute hygroma is 
formed. 

These accidents should be treated first with cool applications and after- 
wards with moist heat and pressure. Blisters, firing, puncture, free in- 
cisions with asepsis are the means recommended for obstinate hema- 
tomas. Suppuration demands an early opening. 

II. 

HYGROMAS— BURSITIS. 

The ordinary causes of inflammation of serous bursae are violent or 
repeated traumatisms, inflammation of surrounding parts (phlegmon, 
lymphangitis, arthritis) and certain general morbid conditions (rheuma- 
tism, strangles, purulent infection). In the great majority of cases hygro- 
mas are due to mechanical causes : the action of the heel of the shoe 
pressing on the elbow when the animal lies down, the pressure and the 
rubbing of parts of the harness on the withers or the poll of the head. 
248 



HYGROMAS— iBURStTiS. 249 

According to the intensity of the local phenomena hygromas are acute 
or chrofiic. In acute hygromas the tumor is warm, painful, oedematous or 
fluctuating. The contents vary with the acuteness of the inflammation : 
although generally serous and mixed with fibrinous clots, it may be hemor- 
rhagic or purulent. 

The therapeutics consist in reducing the inflammatory symptoms and 
preventing suppuration. If the tumor is recent it may disappear by 
the simple removal of the cause. Refrigeration at the beginning and later 
balneation or tepid antiseptic lotions are the best means to use. If 
rheumatismal diathesis is suspected salicylate of soda is to be prescribed. 
With such treatment suppuration is prevented and either resolution takes 
place or the hygroma becomes chronic. When suppuration occurs, free or 
counter-openings should be made to allow the escape of the pus. An- 
tiseptic irrigations followed by the application of a dressing or of absorb- 
ing powders complete the treatment. Sometimes there remains a fistula 
of difficult cicatrization. 

Chronic hygromas are commonly seen in horses and in cattle, with 
which they are accidents of daily occurrence : the elbow, poll, withers and 
point of the hock furnish frequent examples of them. Sometimes they 
follow acute hygromas ; at others they gradually develop under the in- 
fluence of slight but continued irritation. Their wall, first soft, becomes 
indurated or even calcareous. Sometimes they have but one cavity, at 
others they have several distinct or communicating chambers. Their 
internal wall is smooth at the beginning ; later it sometimes has false 
membranes or vegetations (proliferans hygroma). These membranes, 
which are loose, form small foreign bodies called riziform ' grains. The 
contents of chronic hygroma is a viscous, clear or hematic serosity, with, 
perhaps,fibrinous clots or calcareous concretions. 

The walls of the pouch may indurate [fibrous hygroma) and form almost 
the entirety of the growth ; then there is scarcely a small cavity full of 
fluid, in the center of the mass. In cattle, some hygromas reach enormous 
proportions and are covered with large horny growths. 

In the treatment of chronic hygromas, one must; before everything 
else, remove the cause of the trouble : to remove the frictions and the 
rubbings that keep up the irritation is an indispensable condition. Cura- 
tive means vary with the age of the lesion. If the inflammatory symptoms 
are quite severe, if there is lameness, rest is to be prescribed. At the 
outset, astringent lotions, the traditional mixture of vinegar and commoii 
chalk, may prove sufficient. Delwart has recommended the mixture of 
clay, vinegar, and sulphate of iron. Weber advises the following mixture : 

' Rice-formed. 



250 VETERINARY SURGICAL THERAPEUTICS. 

Grams. 

Norway tar .... 450 

Green-soap 450 

Tannin powder 100 

" Every day, after stirring the mixture, a simple painting with a brush 
is made without friction. This application is renewed every day without 
taking notice of what takes place or being frightened at the sloughing 
of large epidermic patches, which come off after several days of treat- 
ment, and which must take place without interruption until recovery. No 
accident is to be feared, for no serious consequence and no scars have ever 
followed." 

Irritating frictions (turpentine, ammonia, spirits of lavender) or blisters 
(charges) ordinarily fail. Straight-line or needle firing is more efficacious ; 
some obstinate hygromas are relieved by cauterization, when the cause of 
the trouble has also been removed. 

The cri/shitjg of the pouch, which is possible when the walls are thin, 
is not sufficient : the exudation returns. 

Asepiic puncture with trocar or bistoury does not succeed better ; it 
permits the escape of the contents of the tumor, but the wound cicatrizes 
rapidly ; the internal unmodified membrane continues to secrete and the 
fluid collection returns. The puncture must be completed by an irritating 
injection. Solutions of iodine succeed well in the treatment of hygromas 
with thin walls. The modus operandi is described in the chapter on 
Tendinous Hygromas. No serious complicatio;is need be looked for. 
Other agents than iodine may be used : carbolic acid, 3-5 percent. ; cor- 
rosive sublimate, i in 1000 or 500 ; thymic acid and a mixture of ergotine 
and muriate of morphine give similar results. It is good, if possible, to 
add pressure after the injection by a wadded dressing, or better, an elastic 
bandage. The last is advised for the knee and fetlock to insure and ac- 
celerate recovery. 

Drainage is sometimes used successfully against some hygromas. Or- 
dinarily a seton, tape, or long tent of oakum is passed through the vertical 
axis of the tumor. This means, which brings on recovery by the suppura- 
tion of the pouch, is objectionable, since it leaves two cicatrices ; and if 
the ends of the seton are tied up, it allows the possible tearing of the skin. 
It is better to have recourse to a drainage-tube fixed by a stitch of suture 
or a safety-pin. Dependent puncture, fixation of a short drain and ir- 
ritating injections constitute a good treatment. 

Subcutaneous discission is a delicate operation, too commonly followed 
by a return of the trouble to be recommended. Ordinary incision is pre- 
ferable. After disinfection of the surfaces the pouch is freely opened, the 
fluid allowed to escape, the clots removed, the rice-formed masses extrac- 



HYGROMAS — BURSITIS. 25I 

ted if there are any, and the vegetations or more or less calcareous pseudo- 
serous membranes are scraped off with the sharp curette. By using cor- 
rosive sublimate or carbolic acid, the radical operation is without danger. 
Curettage of the internal membrane is to be preferred to cauterization, 
actual or potential. The operation is completed by a few stitches of suture, 
an iodoform dressing if possible, or collodion and antiseptic powders. 

Sometimes the walls, fibrous or calcareous, have considerable thick- 
ness. In such a case extirpation may be attempted. If the tumor is 
pedunculated, elastic ligature is the best ; if the base is wide, a sharp in- 
strument is to be used : incise the skin, enucleate the mass without 
opening it, or divide in two and remove each half separately. Well-ap- 
plied hemostasis, sutures, and disinfection afterwards may permit the rapid 
union of the edges without suppuration. This is the ordinary treatment 
of old capped elbows rebel to injections and cauterization. 

Before considering hygromas individually, we will mention, once for all, 
the serous collections that may be found in the various species, particularly 
cattle, on the projecting parts of the body, especially the trochanter, ex- 
ternal angle of the ilium, point of the ischium and external face of the 
thigh. Their treatment is that of recent hygromas, a similar one to that of 
traumatic serous effusions. We especially recommend dependent punc- 
ture, drainage and injections of strong antiseptic solutions. 

SPECIAL HYGROMAS. 

/. Hygroma of the Elbow — Capped Elbow. 

The repeated pressure of the heels of the shoe upon the summit of the 
cubitus, in horses that lie down cow-fashion, produce, on the skin and 
subcutaneous tissues, lesions of various kinds which are classed under the 
general name of capped elbow. If the lesion consists in a dropsical con- 
dition of the serous bursa of the elbow, in a true hygroma it is produced 
in some cases by an acute or chronic inflammation of the skin or of the 
cellular tissue underneath. According to the nature of the alterations, 
capped elbows are cedematoiis, cystic, phlegmonous and indurated. They 
are also divided into old and recent, acute and chronic. 

In the sterno-costal decubitus, the body is supported by the sternum, 
the abdomen and a little of one side of the thorax, it being always slightly 
inclined to the right or to the left. The canon and the phalanges, flexed 
upon the knee, come to lie against the forearm, and as the length of these 
two folded parts is apparently the same, the heels of the shoe can press 
upon the elbow. On many animals this is harmless. If the animal lies 
on its right side, for instance, the right foot comes and rests between the 
chest and the elbow on the coresponding axilla ; the left is carried suf- 



252 



VETERINARY SURGICAL THERAPEUTICS. 



ciently in abduction to have no connection with the olecranon. It seems 
that a special conformation of the knee, reducing abduction, must be 
necessary to bring on this contact with the elbow. Perhaps, also, as Bouley 
says, the relative lengths of the forearm and canon have an influence upon 
the relations of those parts. What is certain is, that most of the horses 

lie cow-fashion, and that 
capped elbow occurs only 
on predisposed animals. 

The best way to prevent 
it would be to tie up the 
animal short enough to pre- 
vent its lying down ; but 
this could not be done 
long. Sometimes by plac- 
ing the animal in a box-stall 
or tying it sufficiently long 
so that it will not assume 
the sterno-costal, but the 
lateral decubitus, young 
animals may be taught by 
punishment not to assume 
this position. Often the 
capped elbow is produced 
by a shoe which is too long ; 
shortening the branches, 
especially the internal, bev- 
eling them, and indenting 
them in the hoof may pre- 
vent the trouble and cure 
recent lesions. The cres- 
cent shoe is advantage^ 
ous. (Fig. 57.) 

A well-shod horse whose 
hoof only rests on the olecranon may nevertheless become affected with 
hygromas. The contact then must be relieved by applications on 
the foot of pads, bags of bran or india-rubber air-cushions (Bouley). 
A thick roll applied above the knee on the canon, the coronet or the 
heels may do well : during the flexion of the leg it presses against 
the thorax and forces abduction ; it also keeps the metatarsal and 
the forearm apart. Zundel advises placing on the back of the knee 
in the direction of the leg a stiff roll of straw secured above and 
below on the lower part of the forearm and the superior portion of the 




Fig. 57. — Shoe-Boil. 



HYGROMAS — BURSITIS. 253 

canon; this will prevent the flexion of the anterior affected leg. Placing 
sharp points or using pads with sharp nails is a dangerous thing to do. 
A good shoeing and simple soft pads are generally sufficient. A muzzle 
is sometimes used to prevent the animal biting its elbow. 

Local therapeutic means can be advantageous only when the region is 
relieved of the bruising action of the shoe or of the heel of the foot. 
The capped elbow when recent is soft and oedematous. Douches, slight 
massage, astringent applications (white lotion, vinegar and chalk) and ex- 
ercise are sufficient to obtain the absorption of the exudation from the 
subcutaneous connective tissue. If the result is incomplete Lebas charges 
or blisters can be used. 

The cystic capped elbow, the true hygroma of the elbow, ordinarily does 
not yield to these means of treatment. Repeated blistering applications 
have been prescribed for it, especially the bi-iodide of mercury. The 
preparation of Weber spoken of above applied daily will, after three or 
four weeks, remove some voluminous hygromas of the elbow. Mr. 
Weber says that this treatment "has never failed with him." Several 
veterinarians have also obtained excellent results from its use. Puncture 
is efficacious only when it is completed by the destruction of the cystic 
membrane. The puncture should be made with the red-hot iron, the in- 
ternal face of the wall should be scorched with it or touched with a 
caustic substance (tincture of iodine, solutions of potash, chloride of zinc). 
Sometimes after the opening a blister or a few points of firing are put on 
the surface of the tumor. Some practitioners still use the vertical seton. 
When the capped elbow is the seat of an active inflammation this can be 
relieved by cold applications, emollients or camphorated ointment. Vesi- 
cating agents to promote suppuration are also used. When the abscess is 
formed a free opening is made, followed by frequent injections. 

A more energetic treatment is necessary with indurated capped elbow. 
Blisters and mercurial frictions have little effect : the Weber preparation 
finds obstinate cases and cauterization does not always succeed. After 
trying all these, if the tumor is quite circumscribed it must be ex- 
tirpated. The ecraseur crushes the tissues and leaves a bruised zone 
which sloughs off by suppuration and retards cicatrization. Elastic 
ligature is always to be preferred when the tumor is somewhat peduncula- 
ted. When it is wide and the application of the ligature somewhat 
difficult, Moller recommends the use first of a very fine india-rubber 
thread, which will not slip so easily. After a few days, when the tumor 
has swollen by hyperaemia and exudation, this thread should be replaced 
by another coarser. The elastic ligature can, however, be kept in posi- 
tion with the aid of a metallic pin pushed through the mass (a kind of 
pin suture). The section of the neoplasm will take from five to ten 



254 VETERINARY SURGICAL TIIERAPF.UTICS. 

days, according to its size. It is better to ha.ve the amputation per- 
formed entirely by the hgature than to finish it with the bistoury : the 
wound heals quickly and leaves but a little cicatrix.' 

Excision is frequently made with the bistoury, but it is often more 
difficult than at first thought, and often leaves a large wound. The ani- 
mal having been thrown on the opposite side and the diseased leg carried 
forward, the region is shaved and disinfected. Two curved incisions 
meeting at their extremities are made on each side of the central axis 
of the tumor, circumscribing a flap of skin, which is removed with the 
mass. By careful dissection, avoiding injuries to the muscles, the anti- 
brachial aponeurosis or the head of the olecranon, the fibrous neoplasm is 
removed ; the edges of the wound are then brought together with silk or 
silkworm-gut, and the whole is covered with a collodion plaster or a dress- 
ing. 

By paying attention to antisepsis union by first intention may be 

obtained, though it is not to be greatly expected in ordinary practice. 

The patient should remain at rest from one to three weeks. In the 

first days following the operation the animal should not be permitted to 

lie down. 

To resume, when the cause is removed recent capped elbows, oedematous 
or cystic, should be treated with antiphlogistics, astringents, the Weber 
preparation or blisters. Phlegmonous growths demand the same treatment 
as abscesses. Being indurated neoplasms, they ordinarily require the use 
of ligature or of the bistoury. 

Once cured, the return of the trouble is prevented by following the 
regulations given above. 

Large-sized dogs which have the habit of lying in a sternal position, 
with the elbows resting on the ground, are exposed to callosities of the 
skin of that region and inflammation of the olecranal bursa. When 
this enlarges it forms a rounded or ovoid tumor, fluctuating and some- 
times accompanied with inflammatory manifestations. In some cases the 
surrounding tissues become indurated. 

Whatever has been the growth of the tumor, and whether its contents 
be serous or sero-fibrinous, recovery is not easy to obtain. Puncture 
is insufficient and ligatures ihold badly. The removal of the sac is the 
preferable method, performed aseptically without exposing the bone and 
then dressed with a wadded dressing. 

' Our experience with the use of the elastic ligature for the removal of these 
tumors justifies us in differing from the author in his conclusions. With us 
and many American veterinarians the wound has always been very slow in re- 
pairing and the cicatrix has been rather ugly. With Myers one case lasted 
from January to May before entirely healed. (Amer. Vet. Review, vol. xi., p. 

121.; 



HYGROMAS— BURSITIS. 



255 



//. Hygroma of the Knee. 



This hygroma that Percivall calls " capped knee," is not rare in horses. 
It is observed principally in those that rise " cow- fashion," and on those 
that have fallen on their knees without division of the skin. It is frequent 
in cattle. Its frequency depends on the way in which animals lie down 
and rise. Some remain a certain time on their knees ; the pressure and 
rubbing on that region wear the hair, irritate the 
skin, lacerate the connective tissue or give rise to 
a serous exudation. Serres condemned the bad 
condition of many barn-floors in southern France, 
and also the habit of having no bedding except 
for the hind quarters. 

In horses, recent precarpal hygroma is generally 
painless, diffuse, spread over the anterior face of the 
knee (Fig. 58) and evenly fluctuating. Whatever 
its size may be those characteristics are sufficient 
to distinguish it clearly from the tumors formed by 
the dropsy of the tendinous or articular synovial sacs 
of that region. In time the walls thicken and be- 
come indurated here and there ; in its cavity float- 
ing bodies (" riziform ") can be detected; some- 
times inflammation occurs and purulent transforma- 
tion follows. In cattle, the growth may reach con- 
siderable dimensions (Fig. 59). Sometimes the 
skin is excoriated more or less deeply ; not un- 
commonly is it indurated, partly ossified and covered 
with a thick horny production (Fig. 60). 

If the build of the barns is defective let it be 
remedied. When the tumor is recent and small, 

irritating frictions (turpentine and ammonia mixed, tincture of canthar- 
ides, camphorated alcohol) or blisters are recommended. These some- 
times succeed when the sero-bloody collection of the connective tissue is 
small ; when it is abundant they fail. Puncture with the trocar is in- 
sufficient; it must be completed with iodine injections. Moderate press- 
ure with the dressing or the elastic band assists in the recovery. 

Freely open the pouch on its dependent side, remove the fibrinous 
clots and rice-formed bodies that may be there, place a drain, and twice 
a day inject carbolic-acid water or weak tincture of iodine : such treat- 
ment will give the best results. 

The seton run vertically is used by many ; the cavity closes by granu- 
lation. A tent of flax or an india-rubber drainage-tube in place, an- 




Fic 



. 5S. — Hygroma 
of the Knee. 



256 



VETERINARY SURGICAL TIIERAPKUTICS. 



tiseptic injections can be thrown into tlie cavity. This treatment is 
followed by induration of the knee. Furlanetto, with the seton, applies 
a blister or a compressive figure 8 bandage over the knee. 




Fig- 59- — Hygroma of the Knee in a cow (from Stockfleth). The tumor 
measured i m. 56 in. in circumference. It was of one year's standing. It inter- 
fered with locomotion. When the foot rested on the ground it flattened 
down on its inferior surface. 

Needle cauterization has given good results in the case of horses. 

When the hygroma is indur- 
ated, deep firing, excision or ex- 
tirpation are necessary. In cat- 
tle, Saussol divided the tumor 
vertically with the bistoury, al- 
most entirely removed the yellow 
lardaceous mass which forms it, 
and cauterized it with the hot 
iron ; after a month the recovery 
was almost complete, but an ugly 
cicatrix was left. Serres made, on 
the most projecting portion of the 
tumor, two convergent curved in- 
cisions, bounding an elliptic flap 
of skin, which was excised with 
the tumor. The whole of this 

Fig. 6o.-Hygroma of the Knee partly ^^^^ ^^^^^ ^^^^^^^^ ^^ thoroughly 
ossified and covered with a horny 

growth (from Stockfleth). '^^^ possible, and a quilled suture 

dressing applied. 

With antisepsis more favorable results can be obtained. The technic 




HYGROMAS— BURSITIS. 257 

used to remove the cicatrices of broken knees is here applicable. The 
synovial membranes should be avoided, solid suture be applied and the 
region immobilized with a plaster spHnt. 

Horny productions on the anterior face of the knees of cattle must 
be extirpated. Interference is obviously limited to cases where the growth 
is not too large and its surface of implantation not too wide. 

///, Hygroma of the Stifle. 

Prepatellar hygroma must be distinguished from the femoro-tibio-patellar 
hydrarthrosis. In some cases the diagnosis is difificult, and both may exist 
together. This hygroma deforms the part, but produces no lameness and 
does not incommode the patient. 

Puncture with the trocar, iodine injections, line or point firing, depend- 
ent puncture with the bistoury, and drainage with antiseptic injections are 
the means used when the diagnosis is established.! 

Once open, suppuration may last for a long lime. It must be treated 
with strong antiseptic or slightly caustic solutions. 

IV. Hygroma of the Hock — Capped Hock. 

The point of the hock is not infrequently the seat of an oedematous, 
phlegmonous or indurated tumefaction, called by old hippiaters " capped 
hock." It starts in inflammation of the subcutaneous serous bursse or of 
the connective layer which unites the skin to the tendon of the deep flexor 
of the phalanges. External blows, kicks, rubbing against the stalls or 
other hard bodies are the causes of this affection. It has sometimes mani- 
fested itself after anasarca, excessive or premature work, slips or violent ef- 
orts (Peuch). It has been observed on both legs without evident cause 
(Furlanetto). Often its growth is so rapid that in one night it may be- 
come as big as a small orange. In the beginning it is often warm and 
painful; its resolution can then be easily obtained. (Fig. 61.) 

To pad the sides of the stall and prevent the animal from rubbing its 
hocks, and from kicking by having the hind legs hobbled together, are 
the first precautions to be taken. The local treatment consists in douches 
and astringent applications — vinegar and common chalk, a mixture of 
clay, vinegar and sulphate of iron (Delwart). If irritations are kept up 

1 The size that this form of hygroma assumes is sometimes enormous. We 
had an opportunity to observe one case where it w.as so large that locomotion was 
entirely impossible. We tapped it four days in succession, removing on the 
first day fifty-two ounces of fluid ; on the second, over twenty-six ; on the 
third, six, and on the fourth puncture, four ounces were again removed. In 
this case suppuration was comparatively small on account of the free use of 
tincture of iodine irrigations which were used. {A. Liautard : Lameness of 
Horses, page 153. 1888.) 
17 



■^'Q 



53 VI- iERIXARY SURGICAL THERAPEUTICS. 

on the parts, the tumor begins to increase in size, to indurate and to as- 
sume a character of chronicity which renders recovery very difficult. All 
kinds of vesicating agents have been tried (blisters of cantharides and of 
mercurial preparations, etc.). The best results have been obtained by 

repeated applications of preparations of 
moderate activity. In these seems to be 
the secret of success. Thus can be ex- 
plained the results obtained with the Weber 
preparation, which has shown itself most effi- 
cacious in numerous old voluminous capped 
hocks. Rest is not necessary ; on the con- 
trary, work is advantageous during the treat- 
ment. 

Penetrating point firing has its patrons; 
we have used it with success, but it is 
slow, not to be depended upon, and leaves 
scars. Puncture is insufficient. Iodine 
injections have given recoveries to Leblanc, 
Cambron, Verrier, Liard, and many others. 
Leblanc's case was the size of the fist, of long 
date, and had resisted many forms of treat- 
ment. The animal was very nervous and 
had to be thrown to receive the injection 
Fig. 6i. — Capped Hock. (i percent, tincture iodine, 2 per cent, of 
water). After fifteen days, the liquid col- 
lection having returned, a second injection was made. Recovery 
was complete. The mare treated by Cambron had a capped hock as big 
as a child's head ; puncture gave escape to one and a half liters of 
fluid. A first injection being followed only by improvement, a second was 
made, and the tumor disappeared entirely. Verrier injected two volumin- 
ous capped hocks on the same horse ; he saw the animal three months 
afterwards entirely recovered. Ahorse treated by Liard (obs. 6) was also 
cured by one injection : after three months the growth was reduced three- 
quarters of its size, and ultimately disappeared. Another horse (obs. 5), 
after the injection, rubbed its hock against the stall, the sac opened, sup- 
purated and filled with granulations ; later the tumor subsided, but the 
point of the hock carried a cicatrix. 

Free incision made without asepsis exposes the lesion to severe compli- 
cations : at times it becomes a suppurative phlegmasia of long duration, or 
the growth indurates and considerably increases. Even when made an- 
tiseptically and completed with a wadded dressing, the operation does not 
seem to have given such brilliant results. Besides, it requires a long rest. 




HYGROMAS— BURSITIS. 259 

Heil says he has cured some capped hocks l)y rupture obtained as 
follows : While the sound hind leg is flexed and held up by an assistant, 
a ligature sufficiently tight to be inconvenient to the horse is put on the 
diseased leg above the hock ; the leg that was raised is let go ; the animal 
mal'.es violent efforts to free itself from the ligature ; the hygroma bursts ; 
its contents spread into the surrounding connective tissue and are absorbed. 
The trouble will not return. 

The same treatment cannot be applied to all capped hocks. In general, 
if the lesion is recent, douches, cold baths, astringents, massage and tan- 
nic liniment are to be prescribed. If the tumor is older, but of moderate 
size, it should still be treated with liniment or light blisters ; if it is larger, 
and has still preserved the character of a cyst, actual cauterization or an 
iodine injection may be selected. With indurated capped hocks of large 
size, needle firing and also tannic liniment should be used. If the growth 
becomes phlegmonous, it should be opened and the cavity washed out with 
antiseptics. 

F. Hygroma of the Fetlock. 

Most authors describe under the name of hygroma of the fetlock the 
distension of the synovial sheath that assists the sliding of the anterior ex- 
tensor of the phalanges upon the anterior face of that region. Thus 
formed, the tumor is ordinarily soft, fluctuating, painless, and well bilobed 
when it is large. We will study it in the chapter on Tendinous Synovial 
Dropsies. The true hygroma of the fetlock, like that of the knee, is sub- 
cutaneous, developed between the skin and tendon. Diffused, spread, 
and sometimes oedematous at the start, it becomes circumscribed and in- 
durated with time, but rarely becomes very large. Its treatment differs 
little from that of benign forms of hygromas of the knee. Recent tumors 
generally yield to pressure, massage or light absorbents. Old hygromas 
demand puncture with irritating injections, cauterization or incision. 

VI. Hygroma of the Canon. 

This is always localized on the internal face of that region, is due to 
blows from the inner side of the shoe or corresponding quarter of the foot 
of animals with irregular gaits, and sometimes it accidentally comes to 
horses with sound standing and normal action. 

Its characters differ. Sometimes it is chronic, and appears under the 
aspect of a soft, elastic tumor, well-defined and without manifest inflam- 
matory phenomena : such a one would be treated with puncture and 
iodine injections or with deep penetrating point firing. Acute and phleg- 
monous, it forms a warm, painful tumor, extending more or less on the 
canon; with its surroundings indurated and its center fluctuating, the only 



2 JO VETERINARY SURGICAL THERAPEUTICS. 

thing to do is to puncture it on the most dependent part. Antiseptic 
care easily brings recovery. If there is undermining of the skin, puncture 
is not enough, because the wound would close too rapidly ; a drainage-tube 
is necessary to permit the escape of pus and the injections of antiseptic 
washes. Seton is less recommendable. 

Hygroma of the Withers. (See Diseases of the Withers, vol.2.) 
Hygroma of the Poll. (See Diseases of the Poll, vol. 2.) 

111. 

NEOPLASMS. 

Tumors of serous bursas are exceptionally rare. The walls of these 
cavities may, however, be the starting-point for neoplasms of various 
kinds : sarcomas, fibromas, myxomas, fibrochondromas and epitheliomas. 
Fibromas and sarcomas are most ordinarily observed. 

The characters vary with the nature of the lesions. The clinical diag- 
nosis is somewhat difficult, since the marked induration of many chronic 
hygromas may resemble a true neoplasm. 

With malignant tumors, early and complete extirpation is here, as in 
similar cases, the only efficacious treatment. Such is it also for benignant 
growths which produce functional disturbances. Cauterization is to be 
used only in cases of induration of an inflammatory nature produced by 
chronic hygromas. 



CHAPTER III. 

MUSCLES. 

I. 

TRAUMATIC LESIONS. 

Bruises {contusions') of muscles have external causes (traumas) and inter- 
nal causes (fractures, luxations). They vary from the slightest excitement 
{inuscular stupor') to complete rupture or crushing. The more elastic skin 
yields without breaking, while the muscle underneath is cleanly divided or 
bruised. Commonly, the alterations consist in fibrillar ruptures with 
bloody infiltration or only in a partial division : hemorrhage takes place, 
the cavity is filled, and a hematoma is formed. 

Rest, douches in some cases, wadded paddings, are the treatment useful 
in the beginning. Even when there is partial or total rupture, the thera- 
peutic is not yet very active. (See Ruptures.) Later, massage is to be 
employed. When a sero-bloody collection remains, it is necessary to have 
recourse to puncture followed by an alterative injection, methodical pres- 
sure or incision. (See Contusions.) If the traumatic center suppurates, 
free openings and antiseptic irrigations are necessary. In cattle, bruises 
of the gastrocnemius are often accompanied with suppuration. Puncture 
and carbolic injections insure recovery. (Stockfleth.) 

Pricks with aseptic instruments heal promptly. If they are infected, 
they are accompanied with severe phlegmasic phenomena and suppuration, 
and must be treated according to the rules indicated in the chapter on 
Pricks in general. 

Wounds with shajp instruments affect the muscle more or less deeply 
and in various directions. If they are parallel to its axis, they have no 
tendency to open widely ; there is but a slight slit, which will close rapidly. 
If, on the contrary, the organ is divided transversely, there is first an 
abundant hemorrhage, both ends separate, and the wound gapes. What- 
ever may be its extent or its character, it must be carefully disinfected, 
especially if the injuring body is dirty ; and the leg must be put into 
the best position to favor the closing together of the ends of the muscle. 
This is sometimes difficult to realize. The leg should be kept extended 
with an unremovable bandage in cases of the section of an extensor, and 
flexed if there is section of a flexor : attempts " may be made to bring 

261 



202 VETERINARY SURGICAL THERAPEUTICS. 

both divided ends together by sutures ; but generally they are cut by the 
threads. Complications must be guarded against ; dressings must be ap- 
plied on the legs ; on the trunk, ordinarily one is satisfied with washings 
and the use of absorbing powders. In most cases a thick fibrous layer is 
formed between the two muscular stumps ; the muscle becomes digastric. 
One must also watch the progress of the repairing phenomena ; it is 
possible that the cicatricial tissue will contract adherences with the sur- 
rounding bone, thus destroying the action of the muscle ; though ordin- 
arily these fibrous adhesions break up and the leg returns to its normal func- 
tion. 

In all animals, contused wounds are the most common and also the 
most serious. They expose them to all the complications of extensive 
traumatisms. The bloody exudation, the laceration of injured parts, and 
the abundant connective tissue interposed between the various muscular 
layers are so many conditions which promote suppuration and the mi- 
gration of pus into more or less distant regions. In the observation of 
RigoUat, ihe great scapulo-humeral muscle had been entirely divided by a 
kick at its insertion in the humerus ; there was a wound twelve centimeters 
long, five wide and four deep. Balls that pierce through a muscle make 
a canaliculate loss of substance. If the wound has been made during con- 
traction of the muscle, when it relaxes the tract does not correspond any 
more to the cutaneous and aponeurotic openings, and if suppuration oc- 
curs, it accumulates in the tract. The wound should be carefully dis- 
infected in every part (irrigation, antiseptic bath), and, if possible, it 
should be protected with a dressing. The wounds of the trunk should be 
irrigated two or three times a day with disinfecting fluids, then covered 
with antiseptic or simply absorbing powders. In the traumatisms of the 
croup or of the thigh, subcrustaceous cicatrization is obtained easily : the 
wound having been disinfected, and then dusted with tannin, coal-tar, 
or charcoal, covers itself with a scab, under which cicatrization goes on 
without abundant suppuration. In wounds made with substances soiled 
by earth, septicaemia and tetanus are particularly to be feared. If the pus 
filtrates between muscular layers, counter-openings should be made. 
Drains will permit the thorough cleansing of the wounds. The thera- 
peutics of tearings does not differ from that of contused wounds. 

II. 

RUPTURES. 

Solutions of continuity of muscles by their contraction are the ones 
which truly deserve the name of ruptures. When traumatic, they belong 
to the chapter on Contusions. 

Muscular tears have been especially observed in horses ; they are not so 



RUPTURES. 263 

common in cattle or dogs, but are seen in swine (Ostertag) and birds 
(Larcher) frequently. Complete rupture of muscles is much less com- 
mon than that of tendons or of bones ; when it occurs, it is either the fleshy 
part which is affected or, as is more commonly the case, the musculo-tendin- 
ous portion. Incomplete ruptures involving only a few fibres are facts of 
daily occurrence : the partial ruptures of the ilio-spinalis muscle in horses 
secured in a recumbent position are frequently observed, (^t^ Myositis.) 

Lesions of degeneration of muscular fibres promote ruptures. In man, 
these degenerations have been observed in typhoid fever, smallpox and 
other infectious diseases ; they are also observed in animals during an- 
alogous affections. Rupture may sometimes occur in muscles absolutely 
sound, under the influence of a violent contraction. Muscles in condition 
of activity have an enormous resisting power. Experiments have shown 
that in dogs the biceps is ten times more resisting during life than after 
death ; from this some have concluded that rupture was impossible during 
the state of contraction for them. Antagonistics are those which would 
bring on distension and rupture of the relaxed muscle ; but inco-ordinated 
contraction may overcome the resistance of the muscular fibre, and it is 
thus that the great majority of ruptures take place. 

In colts and in calves, sometimes, during the few hours following birth, 
one observes pseudo-paralysis of one or several members, due to muscular 
ruptures. On a two-day-old colt which was unable to stand up, and was 
killed, Knoll found the anterior extensor of the phalanges ruptured on 
the right anterior leg. Sussdorf has reported a similar case. Whether the 
accident is the result of powerful contraction of the muscles, as Sussdorf 
believes, or of dystokial difficulty, it is always serious, and treatment ought 
not to be undertaken except on animals of great value. 

In adults, muscular ruptures are observed especially after violent efforts, 
falls, slips or blows. Partial ruptures involve the superficial or the deep 
part of the organ ; long muscles are more exposed than the others ; thin, 
flat muscles, those that are not surrounded by a restraining aponeurosis, 
rupture most commonly in their superficial layers ; the muscles that have 
a thick sheath rupture rather towards the center (Rigot). As the fibres do 
not give way on the same level, the surface of the fracture is always ir- 
regular and ragged. An exudation of blood fills the space left between the 
divided ends. 

Ruptures of the following muscles have been recorded : Pectoral, mas- 
ioido-humeralis, subscapularis, coraco-radialis, extensors of the fore- arm, 
ilio-spi?ialis, antenor crural muscles, bifcmoro-calcaneal, tibio-premciatar- 
sal, and diaphragm. The observations 2, 3 and 4 of the report of Rigot 
relate to the rupture of the subscapularis muscle. Tearings of the 
coraco-radialis are at times partial and again complete. Goubaux has 



264 VETERINARY SURGICAL THERAPEUTICS. 

reported two observations of rupture of this muscle : in a twelve-year- 
old horse destroyed for dissection, he found on both legs a cicatrized 
rupture of the long flexor of the forearm ; in a seven-year patient which 
was very lame in the left fore leg, he found in that muscle five cystic 
pouches, evidences of previous ruptures, and also the cicatrix of a com- 
plete rupture of its inferior tendon. Nesbit has made the post-mortem 
examination of a horse in which on both legs the coraco-radialis muscle 
was torn from its scapular attachments/ Peuch records the following in- 
teresting observation : A horse running away struck against the angle of 
a wall, fell down and had some difificulty in getting up. On examination, 
he found that "a little below the right scapulo-humeral articulation, in 
the middle part of the long flexor of the forearm, there was an oblong 
tumor the size of the fist extending to the middle of the anterior brachial 
region; it was hot and painful." The animal rested only on its toe. 
The general symptoms were such that two days afterwards it was de- 
stroyed. At the autopsy, there was a diffused hemorrhagic center, a 
partial rupture of the mastoido-humeral muscle and on the bicipital 
groove a rupture of the width of two fingers ; also a transverse solution of 
continuity of the coraco-radial muscle. At the autopsy of a horse that had 
hown symptoms of sprains of the loins, Rigot found the great psoas 
swollen, softened and partially torn. In tears of the gluteal muscles, of 
the superficial (long vastus) especially, the diseased leg is dropped, its bony 
supports half flexed ; in walking, the step is shortened, the motion of 
the leg is limited, the toe drags on the ground ; later there is a local 
simple depression, or a deformation of the region brought on by the 
atrophy of the muscle. The troubles of locomotion last sometimes for a 
long while. In a horse cast on the left side for castration, Raynaud 
observed, on the right gluteal region, near the origin of the tail, a some- 
what large swelling, though not very painful ; in walking, the muscles 
of that region contracted with difficulty, the leg was dragged along and 
moved in abduction. The author made a diagnosis of I'upture of the long 
vastus and middle gluteus. There remained a slight motion of abduction 
and a depression at the point of rupture. Partial ruptures and those of 
the patellar \rm?,Q.\e5 are not rare. Delwart, Haubner, Schmidt, Hoffmann, 
and Bassi have recorded dnstances of them in horses; HoUmann and 
Meyer, in cows. Delwart says he has observed the laceration of the 

' Professor Robertson has an animal destroyed because of severe osteo poro- 
sis. There was a great deformy, his body hanging between both fore legs, it 
the scapulae having a horizontal position. At the post mortem it was found 
that on the right side the coracoid process had given way and on the left the 
tendon of the coraco radialis had ruptured about three-quarters of an inch from 
its attachment. (Amer. Vet. Review, vol. 21, p. 623.) 



RUPTURES. 265 

anterior straight muscle ; l)ut the reading of his case shows that the lesions 
he met had occurred during an attack of hemoglobinuria. At the post- 
mortem examination of a horse whose " entire muscular system " was dis- 
colored, Salle and Sergent £ound ruptures of the short adductor, of the 
thigh, and of the external ischio-tibial muscle.* ^ Krashe has recorded 
the case of a horse which was lame for a long while in one hind leg, and 
which one morning was found with it all deformed ; the leg and thigh 
were much tumefied, the femur and tibia almost on a straight line, the 
hock much flexed on the tibia, to such an extent that at each step the 
point of the hock would touch the ground. Having been destroyed, at 
the post-mortem examination the gastrocnemius externus and internus 
were entirely torn at their superior attachment and extensively diseased 
with old degenerating myositis. A plate in Stockfleth's "Surgery" 
shows a cow whose hock almost touches the ground, and in which the 
gemini of the corresponding leg were found ruptured near their femoral in- 
sertion.3 Some muscular ruptures are accompanied with some spinal 
diseases; that of the abdominal muscles ordinarily gives rise to hernia: 
that of the intercostals to pneumocele. In the observation of Jacotin, 
under the title of " Rupture of the Aponeurosis of the Great Serratus," 
as in that of Bouley of " Rupture of the Tendon of the Postea-Spinatus," it 
was a question of a paralysis of the sus-scapular nerve. 

' Dr. Pendry has recorded the case of a trotting-horse which became lame 
and which by the peculiar history he suspected to be suffering with in- 
complete fracture of the femur. After a few days of treatment (shngs and 
blister) the animal was found in the morning with a fracture of the lower 
extremity of the tibia. On making minute dissection of the leg and examining 
the condition of the ischio-tibial muscles he found a laceration of the anterior 
portion of the long vastus muscle, with large ante-mortem clots on its deep sur 
face. (Amer. Vet. Review, vol. 8, p. 412.) 

^ Cases of rupture of the flexor metatarsi are recorded in the American 
Veterinary Review by Abele, in which recovery was quite rapid. After three 
weeks the lameness was hardly perceptible. (Vol. 20, p. 573.) In the observa- 
tion of Ivusk the horse walked quite sound after four weeks and resumed work 
a week later. (Vol. 21, p. 257.) A fatal case is also recorded from the clinic 
of a veterinary college in Chicago, in which at post mortem was found " an 
almost entire rupture of the tendinous portion of the flexor metatarsi with partial 
rupture of the muscular portion. " The accident occurred while the horse was at 
work ; he slipped on the ice, and on attempting to rise his near hind foot slipped 
back. (Vol. 22, p. 767.) 

3 Dr. Schreibler has reported a case of complete laceration of the gastroc- 
nemius tendon in a greyhound, which was completely severed. The separate 
ends of the tendon were about one inch apart and the rupture about an inch 
and a half from the apex of the os calcis. The leg was placed in splints and 
left for about a month, when the dog was discharged. There remained much 
lameness, due to excessive atrophy of the muscles of the leg, (Amer, Vet, 
Review, vol, 5, p. 467.) 



266 VETERINARY SURGICAL THERAPEUTICS. 

The diagnosis is sometimes difficult. Recent complete rupture is 
generally recognized by the swelling, the great abnormal sensibility of the 
region and the functional disturbances, which vary according to the muscles 
affected. Old, it is characterized by the presence of a notch or depres- 
sion, or of two rounded stumps, with functional troubles. In young sub- 
jects and race-horses partial muscular ruptures are often the cause of tem- 
porary lameness and of irregularity of function whose diagnosis is dif- 
ficult, and whose nature ordinarily remains undiscovered. Often the 
lameness has nothing peculiar and the local symptoms are little marked. 

Partial muscular ruptures are repaired rapidly under the single in- 
fluence of rest, and generally leave no locomotory trouble. In complete 
rupture sometimes a long fibrous piece or the separated cicatrization of 
both stumps interfere with the function of the muscle. 

Even in the cases where positive diagnosis is made the therapeutics 
of muscular ruptures is poor. Absolute rest is imposed. In some cases 
unremovable apparatus may be used to bring the extremities of the 
muscles close together. If there is much pain, as in some cases, sooth- 
ing preparations or frequent warm lotions should be applied. At the be- 
ginning the preparations which are generally recommended are of little 
advantage ; later, when the cicatrization is partly made, stimulating fric- 
tions, massage, douches, vesicative agents, cauterizations and irritating in- 
jections are useful. If the hemorrhagic center suppurates, free incisions 
and frequent antiseptic irrigations are required. In a case reported by 
Anacker the rupture of the great psoas was followed by an abscess that 
opened in the abdomen and ended fatally. The suture of the muscular 
ends made aseptically and completed with a wadded dressing has been 
suggested, but in our animals in the ordinary conditions of practice it de- 
mands too much care and too many minutiae. 

III. 
HERNIAS— LUXATIONS. 

Muscular hernias, characterized by the protrusion of a greater or smaller 
portion of a muscle through a laceration of its investing aponeurosis, 
are little observed in animals. They have been seen only on the extremi- 
ties, where they may occur through a solution of continuity in the fibrous 
sheaths which hold the fleshy parts close to the bones. 

They are manifested by a varying enlargement of its size and shape, 
without heat or pain, and which increases in hardness with the contraction 
of the protruding organ. As in all similar accidents, the hernial part 
may become strangulated if the aponeurotic orifice is of very small size. 
Great pain and intense lameness indicate this complication. For simple 



HERNIAS— LUXATIONS. 267 

hernia compressible bandages to hold the organ in place are advisable 
until the cicatrization of the aponeurotic wound is complete. Strangula- 
tion demands the incision of the skin on the surface of the tumor and 
the exeresis of the protruding muscular part, with the closing of the 
borders of the aponeurosis and the suture of the skin. 

With the exception of the displacement of the external ischio-tibial 
muscle, muscular luxations are very rare in veterinary medicine. Yet 
one can conceive that in peculiar circumstances long muscles might slip 
off the bony groove in which they slide and pass in front or behind it. 
The treatment would then be reduction, some restraining apparatus and 
rest. 

We may mention here the case of luxation of the brachial biceps ob- 
served by Dominik in a horse that had run away.' It was manifested 
by very marked flexion of the arm upon the shoulder, very large tumefac- 
tion of the point of the shoulder, slight pain on exploration and drag- 
ging of the leg in walking. The animal was destroyed after three months. 

LUXATION OF THE LONG VASTUS. 

In cattle this muscle, which goes from the sacral spine to the superior 
extremity of the leg, glides over the trochanter by means of a large serous 
bursa. Its anterior border is intimately united to the aponeurosis of the 
fascia lata, which separates into two layers to embrace it. In thin ani- 
mals with projecting trochanter, under the influence of violent pulling 
efforts or by slippings in which the hind legs are powerfully carried back- 
wards in the act of extension, the aponeurosis of the fascia lata may 
divide at the anterior border of the muscle ; the trochanter enters the 
solution of continuity, it is hooked in, so to speak, the muscle is immobi- 
lized and the flexion of the femur is impossible (Fig. 62). 

The diagnosis is easy : the leg carried backwards and outwards drags 
by its toe. It is not necessary that there should be division or rupture 
of the aponeurosis to produce lameness ; in very lean animals the muscle 
may be hooked back of the trochanter instead of passing over it well spread 
(Cruzel). 

With good feeding and rest this difficulty may subside. Fat accumu- 
lating between the layers of muscles and infiltrating them makes the 
long vastus resume its place. Irritating frictions and blisters may be 
used also with advantage in this first stage of the disease. 

But the action of these means is slow and uncertain. Generally prac- 
titioners prefer to operate — the only efficient treatment when there is 

^Dominik; Mittheil. aus der thierarzthl, Praxis. (Gerlach und I<eisering), 
1856, p. 96, 



268 



VETERINARY SURGICAL THERAPEUTICS. 



rupture of the aponeurosis of the fascia lata. Various ways have been 
recommended. Some operate upon the animal standing, others while it 
is down. Quiet animals should be placed in stocks, others must be 
cast and secured. Dorfeuille, Castex, Cruzel, Bernard, Ringuet, Lafosse, 
and Boiteau have described the technic of the operation. 




Fig. 62. — Fascia lata and long vastus in bovines. (i) Anterior border of the 
external ischio-tibial muscle. (2) Fascia lata (Cruzel and Peuch). 



Two conditions present themselves : one in which the animal is thin, 
and the cord formed by the anterior border of the ischio-tibial is promi- 
nent and easily felt ; the other in which the subject is in good condi- 
tion, and it is difficult to locate the situation of the parts. In the first 
case, the section must be made subcutaneously. At eight or ten cen- 
timeters below the trochanter, the operator plunges obliquely the straight 
bistoury under the projections made by the anterior border of the 
muscle ; and after a quarter-circle movement he draws it outwards, 
dividing the aponeurosis and the anterior border of the muscle. If the 
regularity of locomotion has not returned, the instrument is introduced a 
second time and the division completed. When the operator does not 
feel clearly the anterior border of the muscle, he must, on the same stop 



MYOSITIS. 269 

as has been indicated, make an incision of tlie skin and fascia lata four 
or five centimeters long, introduce under the muscle a grooved director 
upwards and backwards, and then in the groove slide the bistoury and 
divide the aponeurosis and the muscle. " The obliquity of the incision, 
and a single introduction of the probe, not of the finger, are sufficient to 
facilitate the escape of the fluid, permit the strictly necessary division of 
the tissues and limit the inflammation unavoidably following the opera- 
tion." ^ The special instruments invented by Boiteau, Gouze, and others 
are not necessary. 

Sometimes a certain hemorrhage follows which requires plugging of the 
wound. Intramuscular abscesses and gangrene are little to be feared. 
Cruzel says : " I have operated at least two hundred and fifty times and 
have never observed deep abscesses or gangrene." This last complica- 
tion is at any rate exceptional in cattle. 

The luxation of the long vastus is veiy rare in the horse. A few ex- 
amples of it are, however, recorded (Eletti, Strebel, Moller). In this 
species the long vastus has not the same anatomical disposition as in 
cattle, and its luxation, instead of taking place backwards, occurs forwards. 
The rupture of the muscle at its insertion on the ischium, or the fracture 
of the ischial tuberosity, seems to be necessary conditions for the produc- 
tion of this luxation (Moller). The muscle being displaced forward, the 
corresponding gluteal region is larger and more prominent than the other; 
its point is in proportion lowered, and when there is fracture, the postero- 
external angle of the ischium is no longer easily detected. The lameness 
resulting from this injury is nicurable. 

IV. 
MYOSITIS. 

Muscular bruises and ruptures are rarely accompanied with violent acute 
inflammatory phenomena, and, as in the case of all subcutaneous lesions, 
suppuration is the exception. On the contrary, open wounds are com- 
plicated with local suppurative myositis when the adhesive union of the 
edges of the wound is not obtained. Some surrounding lesions, especially 
the peri-muscular phlegmasia connected with abscesses or with lymphan- 
gitis, ordinarily spread to the superficial layers of the muscle, thus giving 
rise to simple or suppurative myositis, as the case may be. The treatment 
of these lesions derives its regulations from the therapeutics of contused 
wounds and of deep abscesses. 

In the group of non-traumatic acute muscular inflammations one must 
recpgnize : (i) Spontaneous ox primitive myositis, which affects the " work- 

> La fosse : Traite de pathol, vet., vol. ii., p. 573. 



2^0 VETERINARY SURGICAL THERAPEUTICS. 

ing muscles" and is caused by severe muscular contractions, severe work or 
cold ; (2) symptomatic myositis, which appears in the course of infectious 
diseases or intoxications. 

Primitive myositis is frequently due to the struggling efforts that animals 
make when secured in a standing position, or hobbled while thrown down. 
Every practitioner has observed this. Although the ilio-spinal muscles 
are the most frequently affected, the muscles of the chest, elbow, shoulder 
or hip are equally subject to it. Ordinarily, the general manifestations are 
these : After a variable length of time, the day of the operation or the next, 
the animal is dull, the mucous membranes congested, respiration is ac- 
celerated, the thermometer registers 40 degrees to 41 degrees; a painful, 
hard, tense, and at times oedematous swelling appears in one or several 
regions of the body, most commonly along the ilio-spinalis ; the animal 
walks stiff and sometimes with a great deal of pain. Through the in- 
flamed muscles there are almost always partial ruptures and small hemor- 
rhagic centers. In this form of myositis resolution is the rule. Whatever 
is the region affected, the severe symptoms of the first stage disappear 
rapidly, but there sometimes remains for several weeks a certain stiffness 
of the region. 

With plethoric animals bleeding is useful. Low diet, sulphate and bicar- 
bonate of soda given in drinks for several days are sufficient to remove all 
general disturbances. During one or two weeks there remains a certain 
functional deficiency of the muscle which must be treated by massage and 
resolutive or vesicating friction. As soon as improvement takes place 
moderate exercise hastens recovery. 

If the inflammation is active, especially if there exists in some region 
a purulent center, muscular lesions may become complicated with sup- 
puration (endogenous infection). The swelling increases, becomes 
warmer and more painful, and soon fluctuation is detected. Puncture 
allows the escape of a whitish or reddish pus containing sometimes 
necrosed muscular particles ; the cavity is ordinarily very anfractuous. 
The myositis of the ilio-spinalis occurring in ahorse suffering with " fistulse 
of the withers" or "of the back," may become complicated with diffuse 
suppurative inflammation apd extensive undermining. In one case of 
this kind we have found on the fourth day the ilio-spinalis infiltrated 
with pus. 

When the lesions are not too extensive, the treatment of these muscu- 
lar abscesses is that of purulent collections with or without undermining 
of the skin : puncture, free or counter openings, washing, drainage and an- 
tiseptic irrigations. 

In all cases of serious myositis, the repairing process generally brings 



MYOSITIS. 2^1 

on partial sclerosis of the muscle ; there often remains a local stiffness and 
sometimes a lameness. 

To this myositis of casting may be added that of long-continued use of 
the muscles and of overwork — tnyositis by overwork. Myositis of the 
brachial biceps is quite frequent (Gerlach, Gunther). It is ordinarily ob- 
served in light draught or saddle horses after a quick and long trot. It 
is indicated by a lameness resembling that due to the inflammation of 
the tendon of this muscle and of its sheath over the bicipital groove, viz., 
an abnormal sensibility of the muscle and acute pains with the slightest 
pressure. Rest, revulsives and massage almost always bring on rapid re- 
covery. Friction with a solution of ichthyol, 5 per cent., combined with 
massage, are peculiarly advantageous (Hoffmann). During warm weather 
Rey has often observed muscular inflammations limited to the muscles of 
the shoulder, to the dorsal region, or the croup. There occurred in those 
parts enlargements neatly circumscribed to certain of the muscles. 
" Puncture gave issue to a darkish blood, followed by a small quantity of 
reddish serosity." Out of ten subjects treated, resolution followed 
naturally or with the use of resolutives. " Among the modes of treat- 
ment used, the most efificient consisted in mustard frictions over the 
tumefied parts, which were almost always followed by diminution of the 
muscular swelling. Bleeding was performed also on some plethoric sub- 
jects." In market cattle obliged to take long walks before being slaugh- 
tered, tumefaction of certain groups of muscles and granular degenera- 
tion of those organs are frequently observed. These lesions give rise 
to a lameness more marked when the animal is cold ; the affected region 
is warm and painful. In such cases Furlanetto has often found the sub- 
cutaneous connective tissue of the shoulder, arm, forearm, or of the in- 
ternal face of the leg, infiltrated with bloody serosity ; the muscles of the 
various regions being infiltrated, they are soft and darker in color than 
in the normal state. When the lameness is located in the hind leg the 
same alterations are observed in the muscles of the thigh. Similar ac- 
cidents have been noticed in sheep and swine. The prophylaxis of this last 
variety of myositis is indicated by the etiology : that is, not to demand of 
the animals too tiresome or too long walks. As to the curative treatment, 
it consists of rest, local cold application, massage, resolutive frictions and 
alkaline salts in the drinks of the patient. 

Rheumatismal myositis has been especially observed in horses, cattle 
and dogs, sometimes in sheep and swine. The muscles of the neck, 
shoulder, thigh and loins are more ordinarily affected. Several authors 
have related cases of muscular rheumatism more or less generalized in 
horses. The acute pain, its increase by pressure or motion, the absence 
of well-marked inflammatory phenomena, the erratic character of the 



272 VETERINARY SURGICAL TIIERArEUTICS. 

disease and its liability to a relapse justify a conclusion of rheumatism. 
The pain may involve several muscles ; there are rarely subcutaneous 
cedemas ; most often rheumatismal manifestations are not accompanied 
with local tumefaction, and it is seldom that the disease brings on atrophy. 
In general, pain subsides after a while when the animal is exercised ; they 
stop after sudation. Sternomastoid myositis, which brings on the paresis 
or pseudo-paralysis of the shoulder, is rheumatismal in nature (Moller). 
Sometimes the mastoido-humeral is contracted, well defined and promi- 
nent, and the neck is incurvated (Bassi, Moller). Pulling on the leg and 
on the shoulder backwards produces pain more or less marked. 

The course of this disease is acute, subacute or chronic. The acute 
form may disappear rapidly ; quite often the affection remains in a group 
of muscles, becoming chronic. 

The treatment must be both local and general. Whatever opinion one 
may have of the nature of rheumatism, it must be acknowledged that damp 
cold has a great influence upon its manifestation ; therefore patients must 
not be exposed to it. The horse should be protected by blankets, the 
dog kept in a dry kennel ; cold baths should be avoided. A cooling diet 
is prescribed : milk for old eczematous dogs. Upon the diseased muscles, 
dry frictions or those of camphorated alcohol should be made, with 
turpentine or ammonia. The former when pure, and the ammonia lini- 
ment, are peculiarly efficacious in the case of cattle. Warm washings 
and laudanum poultices may do good. If the affection has a tendency 
to become chronic, liniments, blisters and cauterization are useful. Setons 
are advocated by some. Later, muscular atrophy should be treated by 
continued massage and injections of alcoholic solutions of veratrin (.05 
gram to .10 gram of veratrin, alcohol i to 2 grams). Walking exer- 
cise should be given during the excitement produced by these in- 
jections. 

The internal treatment is less active. Old authors advise the use of 
emetics, the efficacy of which has not been proved. In later years 
salicylate of soda has been used and abused; 100 to 200 grams have been 
given to horses, two to eight to dogs. This salt has a remarkable effect 
in articular rheumatism, but it is now well known that it is less efficacious 
in muscular myositis. Sulphate of quinine, notwithstanding the happy re- 
sults claimed by Caroni, is not more active. Friedberger and Frohner 
have obtained good results with salol (15 to 25 grams for horses, .25 gram 
to I gram for dogs). For this animal antipyrine (.50 gram to i gram per 
day) is advisable). Some practitioners use the tincture of colchicum 
(ten to fifteen drops). Pilocarpine in subcutaneous injections, spoken 
of by Hiibner, has given no success to Siedamgrotzky or to others who 
have tried it, 



AMVOTROPIIIES. 273 

To keep the bowels open by purgatives is a prescription not to be 
neglected. 

Symptomatic polymyositis, which constitutes a clinical concurrence an- 
alogous to polyneuritis, may occur during some infectious diseases. 
Under the title " Observation of General Inflammation of Muscles," 
Auboyer reported in 1833 the case of a horse in which, after serious gen- 
eral symptoms, a number of " muscular projections " appeared on the 
surface of the body, but the* co-existence of swellings of the legs and of 
the head indicates that the case was more one of anasarca than of mus- 
cular phlegmasia. The polymyositis of hemoglobinuria is the much 
more frequent and the better known among animals. 

Some polymyositis, which seems to have no relation with any determined 
disease, is of pyohjemic or septicaemic nature. In man it often repre- 
sents a special form of common septicaemia. 

Chronic myositis may follow acute. Sometimes it complicates the 
presence of hydatic cysts, psorosperms or foreign bodies. But in all 
animal species it may be observed without well-known causes. MoUer, 
Kitt and Piitz have seen in the horse chronic myositis affecting certain 
groups of muscles (forearm, shoulder, thigh). At the autopsy of a horse 
which had been lame on both hind legs for several months, Moller found 
a chronic fibrous myositis of the croup and thigh muscles. Takarenko has 
seen similar lesions almost generalized in cattle. Like Moller, we have 
observed them in dogs, especially on the masseters. Psorosperms have 
been found in cattle, sheep, calves, swine and horses. 

Chronic myositis ordinarily assumes the fibt'ous form, and may bring 
on muscular retractions and bony deviations, giving rise to serious dis- 
turbances in the joints. In the horse it is sometimes ossifying. Megnin 
and Palat have reported an observation of sclero-cartilaginous trans- 
formation of muscular tissue. Stephenson found the muscle flexors of the 
forearm completely ossified. But " progressive ossifying myositis " has 
not been mentioned in the case of animals. 

Whether fibrous or ossifying, chronic myositis almost always resisted 
treatment. Locally, blisters and cauterization can be used, and internally 
large doses of iodide of potassium. 

V. 

AMYOTROPHIES. 

Muscular atrophies, which are somewhat frequent in animals, especi- 
ally in horses and dogs, vary greatly in their nature and in their causes. 
In all species we observe more or less rnarked emaciation, generalized to 
a whole diseased leg, and brought on by inaction or functional insufficiency 
of that leg. We have already spoken of the atrophy of certain muscular 



2/4 VETERINARY SURGICAL THERAPEUTICS. 

groups, more particularly the crural or the gluteal, as frequent com- 
plication of hemoglobinuria. Rarer are the other amyotrophies of infec- 
tious origin. Arterial thrombosis may bring on serious nutritive troubles in 
the muscles that the arteries irrigate, and when the interference with 
the flow of the blood continues and the anaemic muscular zone cannot 
recover the conditions of its normal vitality, atrophy takes hold of it. 
Kiitzner has observed in the case of a horse, with no appreciable 
cause, a progressive atrophy of the femoral biceps and of the superior 
part of the semi-tendinous — atrophy, no doubt, of embolic origin, 
which three months later brought on troubles of locomotion. Slow atrophy 
of the large gluteus has been seen by Roloff, that of the pectorals by 
Blenkinsop. Other authors have recorded analogous cases in which several 
muscular groups were affected. 

As more rare forms, some unknown, others scarcely mentioned in the 
case of animals, but frequent and well classified in the case of man, we 
may mention the myelopathic muscular, the neuropathic and the myopathic 
atrophies. 

The myelopathic amyotrophies, which are met in numerous cases of 
myelitis, have a common origin ; all come from a lesion of the cells of 
the anterior horns of the spinal cord. The anatomical and clinical de- 
velopment is at times rapid (acute myelitis, hemaiomyelia), at times slow 
(^progressive muscular atrophy) . Pure atrophy is the ordinary muscular 
alteration ; in some cases it is accompanied with sclerosis (sclerous atrophy). 
Sometimes atrophy is systematic, progressive and predominant (progres- 
sive tnuscular atrophy of Duchenne) ; in other cases, though less marked, 
it nevertheless constitutes one of the prominent phenomena of the morbid 
group (lateral amyotrophical sclerosis, syriiigotnyelia) ; and in other cases 
it is irregular, not at all prominent, and occurs in various stages of diseases, 
of which it is but an epiphenomenon of little importance (sclerosis in 
patches). 

Neuritic muscular atrophies, which occur because of lesions of motor- 
nerves, have a more or less rapid development. Examples of them are 
common in some species, specially horses. (See Paralysis.) To that 
group to-day the ainyotrophies of articular o?-igin are added. They are 
sometimes marked by a rapidity that cannot be explained by the inertia or 
disuse of an extremity. It is admitted that they are of reflex nature, pro- 
moted by phlegmasia of the nervous branches which are distributed to the 
diseased muscles. 

Myopathic muscular atrophies seem to be independent of all spina 
or nervous alteration — at least of all visible alteration — with the present 
method of investigation. They are considered as primitive, brought on by 
pohrtic troubles localized in the muscle itself. The diseased process be- 



PARASITES— TUMORS. 2;$ 

gins on muscular fibers, which first hicrease in size, break and waste away ; 
the conjunctive tissue prohferates and becomes infiltrated with fat. Some- 
times the afi'ected muscles appear as if hypertrophied ; but it is a pseudo- 
hypertrophy due to the increase of conjunctive and fatty elements : the 
muscular fibre is well atrophied. Erb has gathered the various myopathic 
amyotrophies under the name of progressive muscular dystrophy. The 
two principal forms of this group are the pseudo-hypertrophic muscular 
paralysis of Duchenne and the pivgressive atrophic myopathy of Landouzy 
and Dejerine. 

The treatment of some muscular atrophies of neuritic origin and of those 
due to long inactivity, to arterial thrombosis and to various infections, de- 
mands especially : massage of the affected muscles, moderate at first, and 
gradually increased ; irritating frictions upon the whole region occupied 
by the muscles in process of degeneration, and electro-therapeutics. (See 
Paralysis.) Iodide of potassium is sometimes useful. 

Myelopathic and myopathic amyotrophies seem to be generally fatal. 
To this day they are considered as absolutely incurable. 

VI. 

PARASITES— TUMORS. 

Parasites of muscles are numerous. The psorosperms and trichincs, 
which inhabit the fibre itself ; the cysticcrci, echinococci, botiyomycetcs and 
the actinomycetes prefer the connective tissue. There are no agents 
which can destroy the cysticerci and the trichinae ; only a well-regulated 
prophylaxis can protect man and animals. Let us mention, however, 
the results said to have been obtained by Feletti in the treatment of 
human cysticercosis with the ethereal extract of fern.' 

Against hydatic cysts, medical agents or puncture followed by an injection 
of iodine are now seldom used. Total extirpation, with curettage of the 
culs de sac, is the best remedy. 

Primitive or secondary tumors may be observed in muscles. Their 
diagnosis is easy. The slow process of development of the neoplasm, its 
painless condition, and the absence of fluctuation are sufficient to indicate 
cystic collections and abscesses. The treatment consists in removal, unless 
countermanded by generalization. Lipomas, myxomas, enchondromas, 
sarcomas, and epitheliomas demand total extirpation. 

Actinomycosic tumors should be treated with iodide of potassium, and 
in some cases should be extirpated. Those due to botryomxcetcs resist 
the iodine treatment or give way to it very slowly. (See Actinomycosis 
and Bottyomycosis.) . 

' Feletti : Mercredi Medical, 1894, p. 417. 



2/6 VETERINARY SURGICAL THERAPEUTICS. 

ADDENDA. 

/. Spasjns — Contractures — Cramps. 

Cramps, their etiology and pathogeny, are still much discussed in medi- 
cine for the human species. It is generally admitted that they may result 
from muscular, nervous or vascular lesions. 

Although the most of the observations reported in veterinary medicine 
under name of crafnps relate to the displacement of the patella (see 
Pseudo-dislocation of the Patella), yet in all species, and especially horses, 
spasmodic muscular contractions and contractures analogous to the cramps 
of man are observed, which may occur and have no relation with the dis- 
turbances that may accompany painful cutaneous affections, Hirsemann 
treated a horse which, after a disease of the lungs, was affected with 
spasmodic contractions of the muscles of the neck and of the anterior 
leg on the same side aj; the affected lung ; these contractions occurred by 
spells, and were brought on by the slightest touch on the affected regions ; 
at the same time it lowered its head and flexed and carried forward the af- 
fected leg. The trouble lasted three weeks, and was finally relieved by 
subcutaneous injections of veratrin. Dycer has reported an observation 
of cramp of the flexor muscles of the head, which with the neck were 
flexed to such an extent that the nose touched the sternum ; the front 
legs were carried forward and flexed ; the animal rested on his knees, and 
his body was covered with perspiration. Attempts to raise the head were 
followed by great pain. After several hours the head and neck suddenly 
relaxed, the animal began to eat, and no further trouble was ever ob- 
served.' 

MoUer has seen a horse in which cramps would appear when slight ir- 
ritations were applied to the auricular region. " The introduction of the 
finger into the ear would immediately bring on a violent contracture of the 
corresponding hind leg, which was then carried forward and for a few 
minutes held in an almost horizontal position. The animal was unfit for 
any work, as pressure of the bridle round the base of the ear would bring 
on the contraction. The ears and the peri-auricular region presented no 
visible alteration." Contractures of the olecranoid muscles have been 
recorded. In a case rela*,ed by Moller, these muscles were tense, rigid 
and insensible to pressure ; the animal was very lame ; when at rest the 
elbow was carried outwards. In large animals, contractures of the posterior 
legs are sometimes observed at various intervals and of various duration. 

' Dr. Nesbit has recorded a case of spasmodic contractions of the diaphragm 
(stumps) , which was also accompanied with spasms of the masseter muscles, 
which had appeared after a comparatively short journe}'. He recovered rapidly 
by rest. (Amer. Vet. Rev., vol. xv., p. 452.) 



PARASITES— TU MORS. 



277 



They do not yield to treatment. Sciatic neurotomy tried with them has 
been unsuccessful. 

//, Springhalt 

This is an affection of the hind extremities which is frequent in horses 
and observed also in mules (Bassi), donkeys and cattle (Booth, Furlanetto). 
An analogous anomaly has been observed in the fore legs (Rigot, Delabere- 
Blaine, Goubaux, Hering, Siedamgrotzky, Moller, Jacoulet and Barrier). 
In some cases the trouble is hardly noticeable, in others it is so marked 
that the foot strikes forward against the abdominal wall (Fig. 63). Al- 
though ordinarily it develops slowly, accentuating itself by degrees, there 




Fig. 63. — Horse affected with Springhalt. (From photograph. ) 



are individual cases in which it appears suddenly and without any ap- 
preciable cause. 

A functional anomaly symptomatic of various affections, it is character- 
ized by a sudden, convulsive-like flexion of a leg as it moves. Gener- 
ally it is more easily observed in walking, not so easily detected during 
a trot or gallop. At times it shows itself only at the beginning of work, 
and disappears when the animal is warm ; at others it is less noticeable 
after a little exercise ; again, it may last as long as the exercise or work 
is going on. 

Widely different opinions have been expressed in regard to its nature. 
Numerous authors think that it is the expression of articular lesiovs. 
Carlo Ruini, Solleysel, Jean and Gaspard de Saulnier, La Gu^riniere, 



2/3 VETERINARY SURGICAL THERAPEUTICS. 

Abilgaard and Garsault have localized ii in the hock ; they had noticed 
its appearance in spavined horses. In one case Natt^ found on the articu- 
lar surfaces of the tibia and of the astragalus reddish erosions with irregu- 
lar borders. Busteed asserted that the hock was always the seat of spring- 
ghalt, and that it was due to ulcerations of the astragalus. Varnell and 
Flemming upset that theory by saying that the American doctor had 
mistaken for an ulcer the synovial fossa of the trochlea of the astragalus ! 
Rigot. Rey and Leblanc have observed true alterations of the tibio-tarsal 
joint, changes in the synovia, lesions of the synovial membrane, articular 
foreign bodies, wearing and fissures of the articular surfaces. In horses 
that had springhalt in the fore legs Goubaux and Barrier have observed 
fissures on the humero-radial articular surfaces, and in others that had 
it on the hind legs they have seen similar lesions in the femoro-tibial, 
femoro-patellar and tibio-tarsal joints. The influence of these lesions 
seems small, however, when one considers that they may be found in 
animals free from the trouble, or even may not be found at all in subjects 
that are suffering from springhalt. The dryness of the articular and 
tendinous synovial bursse of the hock, due to a disease of the spine, has 
been considered by Comeny as connected with the manifestation of 
springhalt. Barrier says that the too wide opening of the tibio-tarsal 
angle is the cause of it. The hock is not the only joint which has 
been supposed to be the seat of the disease. Villate, treating a lesion of 
the stifle joint in an animal that had springhalt, fired it ; both diseases 
were relieved at the same time. Pastureau, Bassi, and Chuchu accused 
the stifle joint. Pastureau is of the opinion that springhalt and cramp 
in solipeds are but varieties, or two degrees of the same affection located 
in the femoro-patellar articulation, in which the {nter?ia/ femo7-o-patellar 
ligament, hooked on the inner border of the trochlea, plays a more or less 
important part. " If the hooking is incomplete, the flexor muscles en- 
tering into action meet a resistance readily overcome, to which succeeds a 
sudden flexion, convulsive like, carried to a greater extent than in normal 
state ; hence the springhalt. If, on the contrary, the hooking is com- 
plete, the animal finds itself unable to flex the leg and the cramp exists." ' 
Bassi and Chuchu have shown that it is not the internal femoro-patel- 
ler ligament which is hooked, but the patella itself, on account of a special 
disposition of the femoral trochlea. (See Pseudo Luxation of the Patella^ 
Many have attributed springhalt to muscular, tendinous or aponeurotic 
lesions. For Lafosse and Bourgelat it is a lesion of the flexor muscles of 
the tarsus or of the nerves distributed in it. Boccar and Brogniez think 
that it is on account of the shortening of the muscles of the anterior tibial 
regions, Brogniez is said to have produced it experimentally by placing 
' Pastureau : Journ. des Veter. du Midi, 1849, P- 483. 



PARASITES— TUMORS. 279 

a wooden wedge between the metatarsus and the tendon of the lateral ex- 
tensor of the phalanges so as to stretch it. L. Lafosse considers it only 
a perversion of the muscular contraction. He says : " It is only a spas- 
modic contraction of the flexor muscles of the metatarsus. We have re- 
moved it several times by the section of one or several of these muscles, 
which we have never found in that state of permanent retraction considered 
by Belgian veterinarians as cause of springhalt." Hertwig locates the af- 
ection in the excessive tension of the elevators of the thigh, and recom- 
mends for it the section of the fascia lata. Gunther thought it to be clue 
to an insufftciency of action in the muscles of the croup. Delafond be- 
lieved it a diseased stretching of the tibial aponeurosis, an opinion recently 
accepted by Dieckerhoff. After a minute study of the part played by 
aponeurosis in locomotion the Berlin professor has pretended that spring- 
halt is due to the shortening of the tibial aponeurosis, followed in time by 
the atrophy of the ilexor muscles of the metatarsus. In an interesting 
paper Wolf sustained the theory of Dieckerhoff. Orillard believes spring- 
halt related to laceration of the muscles of the gluteal and posterior tibial 
regions or to partial ruptures of the cord of the hock. 

The nervous etiology of springhalt has from the start counted many 
advocates. We have already named Lafosse and Bourgelat. Youatt and 
Spooner attribute it to the lesions of the great sciatic nerve, which " irritates 
too violently " the flexor muscles. Perciwall attributed it to disordered 
muscular contractions brought on by affection of the cord or the nerves 
of the hind leg. At post-mortem examinations of animals thus affected 
Renner has always found a chronic inflammation of the great sciatic 
nerve, and for him the spasmodic contractions of the flexor muscles of 
the tibia and hock must be due to this chronic neuritis. Vachetta, taking 
the theory of Renner anew, gives the facts a different interpretation. For 
him the paresis of the muscles supplied by the great sciatic nerve (biceps 
femoris, semi-tendinosus) gives rise to a predominance of action in the 
anterior muscles of the leg. Merle, Rousseau and Comeny think that 
springhalt is due to medullary lesions. 

Some authors attribute it \.o foot alterations. Watrin has advanced a 
theory that Weber, Lavalard and Montagnac accept for certain cases'. 
He says : " By the action of the tendons of the flexor of the digits the 
flexion of the hock forcibly carries with itself that of the phalanges ; then 
let us suppose that for any cause the flexion of the phalanges meets with 
an obstacle, the animal will make an effort to overcome it ; if this dis- 
appears suddenly by reason of the force used, the flexion will be exaggerated, 
and in some cases springhalt will appear." Watrin especially suspects 
the contraction of the external quarter of the foot and the rolling in 
Qf the corresponding cartilage, which, hitting against the posterior face of 



2So VETERINARY SURGICAL THERAPEUTICS. 

the second phalange, constitutes an obstacle to the free movement of 
the phalanges and produces the springhalt. Ch^nier thinks that spring- 
halt is due to a lesion of the intra-horny tissues generally to pain or pres- 
sure taking place at given moments of the walk. To back his opinion, 
he says that horses that have cracks in the toe or the mammae of the foot, 
or that have deformities of the hind feet, as in laminitis, do frequently 
have springhalt. He remarks that the symptoms diminish by exercise, 
as the tissues of the foot become accustomed to the painful irritations, 
and that if the disease were seated in muscles, tendons or aponeurosis, 
the irregularity of action would increase by work. 

Like Gunther, many authors (Dieckerhoff, Bassi, Trasbot, Weber, Chu- 
chu, and MoUer) admit to-day that springhalt is a symptom of a great 
many different lesions. With Moller, springhalt can be divided into 
idiopathic (without visible occasioning cause) and symptomatic, when due 
to lesions of various nature and seat (bony diseases of the hock, scratches, 
blows, seams, laminitis, quittor, keraphyllocele, canker). 

In fact, springhalt is always a secondary symptomatic affection. The 
spasmodic contractions which essentially characterize it are of a reflex 
order and promoted by lesions very diversified in their nature and localiz- 
ation, sometimes visible and at other times incapable of diagnosis, and 
often incurable. 

Let us see now the forms of treatment recommended for it. We will 
speak only for memory's sake of the antispasmodics (belladonna, aconite, 
stramonium) used by Renner to overcome " the spasm of the posterior 
crural muscles." Vachetta has had some success with acupuncture and 
irritating frictions on the biceps femoris and semitendinous muscles, which, 
according to him, are in process of atrophy. But little can be expected 
from blisters or firing of the hock. 

Some authors who, like Percivall, Lafosse and Merle, admit a nervous 
lesion, have tried the resection of the anterior tibial nerve, the principal 
branch of the small femoro-popliteal nerve. The operation is easy : The 
horse having been cast on the side opposite to the diseased leg, the opera- 
tor, placed behind this leg, incises the skin parallel to the tibia on the 
external side of the superior extremity of the bone, where the nerve, 
easily found, runs in an oblique direction downwards and forwards. A 
second stroke of the bistoury divides the tibial aponeurosis, and the nerve, 
very near the surface there, is immediately exposed. The following 
steps are those of all nervous resections. This neurotomy has never 
given very satisfactory results. 

T\i& section of the great sciatic ;/,?r7'^ (posterior tibial nerve) above the 
hock, succeeds when the lesions are seated in the inferior parts of the leg. 
(See Tendinitis.)^ 



PARASITES— TUMORS. 28 1 

The section of the tendon of the lateral extensor of the phalanges was 
recommended by Boccar as early as 1845. Having found that tendon 
retracted and hard, he divided it at the point of its junction with that of 
the anterior extensor of the phalanges, and obtained a complete recovery. 
To perform the operation, the animal is cast on the sound side ; the 
affected leg is either left in the hobble or carried over the correspond- 
ing fore leg ; the skin is shaved and disinfected ; the straight tenotome is 
planted on the posterior border of the tendon, then under it to the middle 
of its metatarsal region ; the curved tenotome is then substituted for it. 
The instrument well in place, the tendon is divided by bringing it in con- 
tact with its sharp edge. The wound, covered with a little iodoformed 
collodion, cicatrizes rapidly by first intention. A removal of a small piece 
of the tendon (Delwart) has been suggested, but this practice has no real 
advantage except to retard the cicatrization. When the animal has got up, 
it is not unusual to see that the phalanges do not extend sufficiently, the 
fetlock flexes forward and strikes on the ground ; but after a few days 
the regularity of the gait returns. There are cases in which, as in the 
first case of Boccar, springhalt subsides immediately. More commonly, 
the irregularity of the flexion motions disappears gradually, while cicatriza- 
tion goes on, and the animal is given light exercise. It would be ad- 
vantageous to have the animal walked during the time following the 
operation. 

Performed by Delwart, Brogniez, Foelen, Trinchera, Palat, Sergent, Guit- 
tet, Ge'rard, Humbert, Adrian and Blaise, this tenotomy is said to have been 
successful in numerous cases. Sergent has recorded fourteen observations 
with the following results : Nine complete recoveries, four almost com- 
plete, and one improvement. These are very encouraging. Out of six 
horses tenotomy of the lateral extensor has given to Adrian and Schelameur 
four successful cases, one half successful and one failure ; Blaise has had two 
successful cases and one failure ; Moller has also been successful. We 
have been less fortunate. Like Siedamgrotzky, we have failed in produc- 
ing springhalt, operating as Brogniez did, and upon three affected animals 
the section of the lateral extensor has failed.' 

According to Dieckerhoff, it is preferable, in case of principally long- 
standing springhalt, to cut both the tendon and the tibial aponeurosis. 
The horse having been thrown on the sound side, the shank is tied up 
above the hock with a cord or elastic ligature to cut off the circulation 
and facilitate the reaching of the aponeurosis at the place of operation. 

' Dr. W. H. Curtis has operated on a large horse and removed about half an 
inch of the tendon, operating close to its union with the extensor pedes. The 
case was one of two years' standing and very severe. Recovery was perfect. 
(Amer, Vet. Rev., vol. xx,, p. 497.) 



282 VETERINARY SURGICAL THERAPEUTICS. 

The surgeon incises the skin below the hock on the terminal tendon of 
the peroneo-phalangeal muscle ; in the incision he introduces the blunt 
tenotome upon the aponeurosis, which he cuts transversely. Theti the 
pointed tenotome is introduced under the tendon and divides it trans- 
versely. The curved tenotome can also be used in this second step of 
the operation. Wolff has obtained several successful results with this 
method of Dieckerhoff. 

Hertwig has recommended the section of the fascia lata. The animal 
having been cast on the sound leg, a short inci'sion is made eight or ten 
centimeters below the angle of the hip, into which a grooved director 
is introduced under the fleshy portion of the muscle. The straight bis- 
toury, guided by this director, divides the muscle from within outwards. 
In this way Bassi has cured a mule. 

The section of the cord of the flexor metatarsi has been suggested. The 
animal is thrown on the lame leg, the upper leg being carried forward and 
secured on the upper fore leg. Above the hock the cord is easily felt. 
On a line between the lower and middle third of the tibia, with the 
straight tenotome the skin and tibial aponeurosis are punctured and 
pushed under the cord. The curved tenotome is then introduced in its 
place and the tendon divided from backward to forward. A coat of 
iodoformed collodion closes the wound and cicatrization takes place rapidly. 
But ordinarily the trouble continues as before. 

Pare the foot plumb, taking for guide the axis of the digital region, 
and treat the contraction, if it exists, are the rules of Watrin's treatment. 
The unshod foot is poulticed with clay for several days, and then a shoe 
with ears is placed on it. Every ten or twelve days, the shoe is spread, 
the feet widen, the cartilages, '" softened, do not longer hook against the 
second phalanx." In some horses whose feet are much contracted the 
springhalt subsides gradually and disappears with this treatment (Weber, 
Montagnac). 

For Bassi, the sectio?i of the internal anterior patellar is the operation 
which offers the best chance of success. (See Pse into- Luxation of the 
Patella:) 

Upon an animal suffering with springhalt of both legs, we have suc- 
cessively, and without noticeable result, performed the section of the an- 
terior tibial nerve, of the lateral extensor of the phalanges, of the plantar 
nerves below the fetlock, and of the cord of the flexor metatarsi. We in- 
tended to divide the internal patellar ligament, but we lost sight of the 
case. In another, where the springhalt was very severe (Fig. 63) we 
divided the great sciatic nerve on the lower third of the leg ; four days 
after the operation the function of the leg was normal \ a month later the 



PARASITES — lUMORS. 283 

hoof sloughed off, and the patient was destroyed. The irregularity of 
the function had not returned. 

It is seen that the therapeutics of springhalt is no less complicated than 
the etiology. To treat it properly, the cause must first be known. 
Correct the standing of the foot if it is defective, treat the painful lesions 
which may exist, perform the operation of Boccar, patellar desmotomy 
or sciatic neurotomy, according to the case ; such are the most frequent 
directions. We are at present without means of treatment for the spring- 
halt due to medullary lesions and muscular or nervous affections of the 
superior regions of the leg. 

For the springhalt of the fore legs, if proper shoeing does tiol relieve 
it, plantar or median neurotomy might be tried. 



CHAPTER IV. 
TENDONS. 

I. 
CONTUSIONS. 

All superficial tendons, but more particularly those of the extremities, are 
exposed to contusions. The tendons of the flexors of the phalanges of 
the anterior extremity, in animals that forge, overreach, or interfere, and 
those of the hind legs in animals that kick backwards, are at times the 
seat of an inflammatory, oedematous swelling, very painful, and due to 
bruised traumas. As will be seen later on, however, true tendinitis {nerj 
ferrure), in the etymologic acceptation of the word, is relatively rare. 
The inflammatory lesions of those tendons are almost always the con- 
sequence of sprains {efforts) or stretching produced during locomotion. 
On account of the structure and weak vascularity of the tendinous 
tissue, the ordinary characters of contusions are less marked than in 
other tissues ; on the other hand, the progress of the inflammatory pro- 
cesses is slow and the pain often very severe. 

The treatment is that recommended in the chapter on Contusions in 
general. Antiphlogistics first, massage and resolutives later, constitute the 
principal agents. (See Tendinitis^ 

II. 
. WOUNDS 

Wounds and subcutaneous tendinous ruptures will be considered sepa- 
rately. Although these lesions are manifested by functional signs about 
alike for a given tendon, their prognoses differ considerably. In ruptures, 
the traumatic center is protected from infectious agents, and cicatrization 
takes place quickly and almost always without complications ; to avoid 
the elongation of the divided cord is all that the surgeon has to guard 
against. On the contrary, the wounds, like all exposed traumas, are sub- 
ject to numerous complications, particularly to tendinous quittor or sup- 
purative tenosynovitis. 

In horses and cattle, pricks of tendons are particularly common on the 
284 



WOUNDS. 285 

legs. The plantar aponeurosis is frequently affected by a puncture wound 
of the foot ; the perforatus and perforans tendons are sometimes wounded 
at the canon or the fetlock by forks or other sharp bodies. At all times 
these lesions have been considered very serious ; yet their rapid cicatriza- 
tion is possible. What makes them dangerous is the infectious condition 
of the injuring body ; if this does not deposit in the wound phlogogenous 
germs, there is only a temporary pain with production of a small fibrous 
nodule ; which soon disappears. Like Furlanetto, we have sometimes seen 
remaining at the point of the cicatrix a morbid sensibility, occasioning 
lameness of long duration. On the contrary, wounds made with soiled 
instruments have a serious prognosis ; too often they bring on acute sup- 
purative tenositis, at times complicated with synovitis. (See Tendinous 
Quittor.) 

Sharp or bruising bodies may produce longitudinal, oblique or trans- 
verse solutions of continuity of tendons. Transverse section is primi- 
tively complete in some cases ; in others, the sound fibres break under 
the weight of the body or of a powerful muscular contraction ; and again, 
a bruised, contused tendon may become the seat of a necrotic inflammation 
bringing on its complete rupture. Whether the division, however, is 
primitive or secondary, the final result is the same ; peculiar functional 
disturbances appear in each tendon as soon as it ceases to fulfil its special 
part. The tendinous stumps are more or less apart ; the upper one, pulled 
by the muscular contraction, draws up within its sheath ; the lower one 
does not obey any more the articular motion likely to displace it ; and 
often the space which separates them is filled with bloody exudation. 

The treatment consists in disinfecting the wound, bringing the tendin- 
ous ends together and immobilizing the traumatic region. If the frag- 
ments of the tendons are close together and have but little tendency to 
become displaced, asepsis of the trauma, and a supporting bandage or a 
special apparatus to hold them in good position, will only be required. 
When the separation of the divided ends is well marked, it must be re- 
duced as much as possible by acting upon the tendon itself or by modi- 
fying the position of the bony levers. In some cases suture is to be used ; 
it gives excellent results in human surgery. 

For tenorraphy, silk or silkworm-gut is preferred. When apposition is 
possible, without great extension of the tendinous ends, ordinary suture is 
sufficient. Composed of parallel fasciculi separated by connective tissue, 
tendinous tissue cuts easily ; therefore, when it is necessary to employ a 
certain traction to obtain juxtaposition, it is better to have recourse to the 
means used in human surgery. 

I. Mode of Le Fori: "Towards the border of the tendon (superior 
end), and from forward backward, a needle is introduced, carrying its 



286 



VETERINARY SURGICAL THERAPEUTICS. 



thread ; then the opposite border is again run through by the needle from 
backward forward, thus forming a loop on the anterior face. The same 
process takes place with the lower end, but in passing the two threads 
successively from backward forward, and then twisting or knotting them 
together." (Fig. 64.) 

2. Mode of Wolfler : "The thread passes through the upper end twice, 
then through the lower end also, and is secured on the side." ' (Fig. 65.) 






Figs. 64, 65, 66. — Tendinous sutures. 



3. Afode of Le Dcntii : "In which there are two sutures, one of juxta- 
position and one of support, which are passed through both tendinous 
ends." (Fig. 66.) 

When it is not possible to bring the ends together, a suture apart is 
made with catgut, or the suture by anastomosis. 

Then a cutaneous suture is made with or without drainage, and a dress- 
ing put on ; the non-resorbable threads are removed after four or five weeks. 
Long rest is necessary. 

Up to this day but few operations of this kind have been performed 
on animals, and the results have not been brilliant. Upon a steer whose 
tendo Achillis was cut, Furlanetto sutured the ends with silk, but all ant- 
iseptic precautions not having been carried out, the wound suppurated, 
the sutures became loose, and the tendinous ends necrosed. (See Wounds 
of the Cord of the Hock.) As the author says, this failure could have 
been avoided with vigorous antisepsis. 

When suppuration is already present, or if there is partial necrosis and 
tendinous sloughs, then tendons surround themselves with a thick fibrous 
cicatricial layer which unites the tendons to the surrounding parts, and 
the movements return only very incompletely. At times the leisons are 
very extensive. In a steer wounded on the right hind cafion with the 
blade of a plow, Furlanetto found a section of the perforatus, perforans 

^ Lejam ; Traits de Chirurgie de Duplay and Recher, t, i, p. S15, 



WOUNDS. i^f 

and internal branch of the suspensory Hgament without any injury to the 
principal metatarsal bone. In cases where such serious lesions exist, and 
in general where there is complication of synovitis or arthritis, no treat- 
ment is justifiable. 

SPECIAL TENDINOUS WOUNDS. 

All superficial tendons are exposed to traumatisms ; all can be in- 
volved in wounds. On the extremities these lesions are peculiarly com- 
mon on the cofd oi the hock, the extensors ^Xid flcxo7-s of \.\\t foot. 

I. Tendo Achillis. 

On account of the situation and the projection above the point of the 
hock, the tendo Achillis and the tibial portion of the perforatus, they 
are much exposed to external violence. Their complete section, observed 
in horses, cattle, dogs and swine, brings on the functional incompetency 
of the leg. If the animal rests upon this leg, the canon flexes under the 
weight of the body, the croup drops down on the corresponding side, the 
posterior face of the metatarsus and of the tarsus has a tendency to come 
into contact with the ground, and it walks like a plantigrade (Fig. 67). 

Spontaneous recovery may occur in all species. Bouley, Jr., men- 
tions the case of a horse which recovered spontaneously from a complete 
section of the tendo Achillis produced by the thrust of a sword. Four 
months afterwards there remained no trace of the accident. St. Cyr has 
seen a six-month-old pig recover without any care, and also a heifer 
which had rupture of the cord of the hock with extensive wounds and 
sloughs. Collin records the history of four dogs upon which the cord of 
the hock had been cut on one leg to prevent them from running out 
with a hunting party ; four months later they ran off again, when a similar 
operation was performed on both hocks ; six months later they were 
permitted and able to return to their hunting. 

These natural recoveries are not, however, to be depended upon, and 
in all cases the practitioner must try to reduce the extent of the cicatrix, 
which is often accompanied with a great elongation of the tendon — even 
of seven centimeters in the case of Barthe'lemy, which required the destruc- 
tion of the horse. 

To keep the tendinous stumps in contact and prevent complications 
are the two principal objects in view. ^ This is no easy task in our large 
animals. The patient should be placed in a suspensory apparatus (slings) 
and the leg immobilized in extension. For this several means are re- 
commended. To hold the two hind legs together with hobbles (I)elorme) 
is not enough. To fix the leg in extension with a hobble, the chain or 
rope of which is secured to a wall behind the animal (Vigney), seems to 



28a 



VETERINARY SURGICAL THERAPEUTICS. 



us not at all practicable. Collin, having to treat a saddle mare v/hoses 
tendons were cut, surrounded the hock with oakum, applied wooden splint, 
on each side of the hock, and held' those with bandages. Excoriations 
of the skin demanded the removal of this dressing. The mare recovered 
and four months afterwards it was difficult to see that she had been so 
seriously injured. Gillet has had recourse to a more complicated treat- 
ment. Two fiat pieces of wood (splints) were cut to fit the lateral faces 




Fig. 67. — Section of the Tendo-Achillis (photograph). 

of the regions extending from the superior parts of the shank to the fetlock 
and then to the ground, and after being well padded were secured on the 
injured leg by three leather straps. The animal was kept in shngs thirty 
days ; after that was turned loose. It was five months before he could 
resume work. While the walking was regular there remained a slight 
lameness in trotting. The apparatus of Relier might be used with ad- 
vantage in such cases. (See Fractures.) 

By careful disinfection and some stitches of suture the adhesive cica- 
trization of the wound is possible, but ordinarily suppuration occurs. 



WOUNDS. 289 

For the dressings tepid antiseptic solutions and iodoform are preferable 
to the tincture of arnica or aloes used in past times. Recovery is always 
slow ; generally the lameness does not subside for three or four months. 
The tendinous suture has been tried by Furlanetlo in a seven-year-old 
small cow, in which the skin and tendo Achillis had been cut five cen- 
timeters above the os calcis. The animal was operated upon standing. 
The leg being held in extension, the tendinous ends were held together 
with two thick silk threads and the cutaneous wound closed with an in- 
terrupted suture. The leg was enveloped in oakum, an iron splint was 
placed on the anterior face of the leg and wooden splints on the two 
sides ; the whole was kept in place by an immovable dressing. The 
animal having been left free, showed no serious symptoms. A strict anti- 
sepsis had not been used, on the eighth day there was escaping from the 
wound a fetid, yellowish fluid ; two days later necrosis of the tendinous 
ends was observed. The animal was destroyed. 

//. Tendons of the Extensors of the Phalanges. 

The tendons of the anterior and lateral extensors of the phalanges may 
be the seat of complete transverse solutions of continuity. The digital 
region is no longer extended on the canon and the anterior face of the 
fetlock participates in the support of the leg, as in cases of paralysis of the 
external sciatic popliteus. 

When at rest, the fetlock having but little tendency to flex forward, 
the dieresis of the extensor tendons is less serious than that of the flexors. 
By immobilization and simple care of the wound the union of the tendin- 
ous ends takes place rapidly and the normal functions of the leg soon 
return. In one case of a wound of the anterior face of the right posterior 
canon, with rupture of the tendon of the anterior extensor of the phalanges, 
Chaintre first used white lotion; a piece of bone sloughed out, the wound 
was then dressed with alcohol and tincture of aloes. Protruding granula- 
tions and a fistulous tract retarded the cicatrization, which took seven 
weeks. As the tendinous stumps had not been kept closed together a 
fibrinous band five centimeters long took place between them ; extension 
remained imperfect for a long time, but the leg ultimately recovered all 
its normal functions. 

An antiseptic treatment would be followed by a more rapid recovery 
and would prevent infectious complications. 

///. Tendons of the Flexors of the Phalanges. 

Partial cuts and contused wounds of \.\\e flexor tendons ordinarily are 
repaired without complications when treated antiseptically. Exceptionally, 
the wounded tissues, especially the paratendinous connective tissue, be 
19 



290 



VETEUIXARY SURGICAL THERAPEUTICS. 



rome the seat of a hypertrophic chronic inflammation, which results in 
the formation of a fibrous tumor that may acquire large dimensions. 
We have operated upon a horse affected in the left hind leg with a similar 
lesion of one year's standing (Fig. 68). The growth was removed with the 

bistoury and the wound covered with 
an iodoform dressing. The cicatriza- 
tion was completed in two months.' 

The section may involve either of the 
tendons or both at the same time, and 
occupy the coronet or the metacarpo- 
phalangeal region. Less serious when 
in the middle of the metacarpus than 
when on a level with the tendinous 
sheath, it is manifested by a dropping 
of the fetlock, more or less marked 
according to the lesion. If, as in the 
case of Lapotre, the perforatus alone 
is cut, the fetlock drops backward but 
little, but if both tendons are involved 
and, a fortiori, if the suspensory liga- 
ment itself is injured, the deviation of 
the fetlock is well marked, and at 
times the ergot comes in contact with 
the ground (Clichy, Bouley, Degive, 
Brandis). In a number of cases, 
those of Bouley and Louis among 
them, recovery has been obtained by 
irrigation or simple dressings without 
the use of any special apparatus. In 
Louis's observations the horse had 
both tendons cut, the sesamoid sheath 
was widely open and the bone involved. The horse, being very nerv- 
ous, was put in slings. Treated with continued irrigations and dressings 
with chloride of lime, he recovered in two months. Lapotre applied a shoe 
with heels four centimeters high to prevent the dropping backward of 
the fetlock ; the wound having been well washed was covered with a 
dressing and filled in thirty-five days. Thick heels and elongated toe- 




Fig. 68. — Fibrosu Tumor Developed 
after a Contused Wound of the 
Flexor Tendons of the Phalanges. 
(Photograph.) 



' We had a case similar to the one represented in Fig. 68 of several months' 
standing, in which amputation, dissection and cauterization failed to control the 
constantly rapid increase of the growth. We at last resorted to the use of 
compressed sponges, and after six weeks of careful dressing succeeded. The 
case was recorded by Dr. Walrath.— American Vet. Review, vol. x., p. 267. 



WOUNDS. 



291 



shoes were applied later. The animal was gradually returned to its work. 
When both tendons are cut the fetlock joint must be supported to 
prevent the too wide separation of both ends of the tendons. For this, 
as advised by Bouley, one may use a shoe with long branches bent 
upwards and resting backwards on the phalangeal column, and thus 
preventing the dropping of the fetlock. By this means the tendinous 
cicatrix is short, and its retraction permits the return to normal standing 
of the digits. Clichy, having to treat a complete section of the flexors of 
the right hind leg, had a bar shoe made with long toe and long branches, 




Fig. 69. — Apparatus to support the fetlock in cases of section of the flexors 
tendons of the foot. (Defays). 

and having at the toe and middle of the bar two holes with thread, to 
which were screwed two metallic rods extending to the hock. These, 
well padded, were secured above and below the hock with leather 
straps. A simple dressing of tincture of aloes with adhesive plaster was 
put on and the animal left at liberty. 

Gourdon and Brogniez have also recommended special apparatus to 
support the fetlock. But all present more or less inconvenience which 
does not permit of their use in all cases ; besides, the fact that the limited 



292 VETERINARY SURGICAL THERAPEUTICS. 

and continued immobilization of the parts, which they require, may bring 
on ankylosis. 

To obviate this inconvenience, Defays has invented a special apparatus 
which has given him very good results, and has the advantage of permit- 
ting motions up to a certain extent, and prevents the possibility of gangrene. 
Like all others, however, the apparatus demands watching.' 

Some authors prefer to these special apparatuses, fenestrated immovable 
bandages. These are made with starch, plaster or other like substance. 

To resume, in the presence of a section of the flexor tendons of the 
foot one must : (i) Place the animal in a sling or let him loose in a box ; 
(2) apply upon the lower regions of the leg a supporting bandage or one 
of the apparatuses above named (shoe of Bouley, orthosome of Brogniez, 
apparatus of Defays), which are used to prevent the dropping of the 
fetlock ; (3) treat the wound with antiseptic dressing or continued irriga- 
tion. 

In the fortunate cases, after thirty or forty days, the tendinous con- 
tinuity is re-established, and the supporting apparatus can be removed. 
To avoid too much straining of the cicatricial tissue, a thick high- heeled 
shoe should be put on. Towards the end of the second month the animal 
can resume work. There may remain a little lowering of the fetlock, but 
with the gradual retraction of the tendons, this will soon disappear. With 
small animals, the suture of the tendons would shorten the duration of the 
repairing process. 

III. 

SUPPURATIVE TENOSITIS— TENDINOUS QUITTOR. 

The inflammation of the tendons — tendinitis, tenositis — \s primary or 
secondary, aseptic or infectious. It will be seen further on that with sub- 
cutaneous lesions it has a tendency to resolution, when not kept up or ag- 
gravated by muscular action or tractions made upon the diseased tendon. 
In exposed lesions, on the contrary, the tendinous tissue, inflamed, softened 
and infiltrated with pus, is often affected with partial necrosis, which 
gradually spreads, sloughing being powerless to eliminate the whole of the 
diseased " core " and stop infection. This necrotic inflammation of the 
tendons is frequent on the inferior regions of the legs, where it is still called 
by the old name of tendinous quittor. 

This is the affection described by old hippiatres under the name of 
" nervous quittor." According to most of them the essential lesion af- 
ected the tendons ; according to Lafosse, Vitet and others, it was an in- 

» Defays : Annales de Medec. Vet., 1858, p. 577. 



SUPPURATIVE TEXOSITIS— TENDINOUS QUITTOR. 293 

flammation of the large sesamoid sheath. Pathological anatomy tells us 
that there is at times tenositis and again teno-synovitis. 

The suppurative inflammation of the tendons of the extremities has 
infection as its essential cause. As a frequent complication of ab- 
scesses, overreaching, cutaneous quittors, synovitis and wounds of all kinds 
affecting tendons, it is early manifested by positive phenomena : by very 
great lameness, excessive dumbness, tumefaction and induration of the 
region, and by the presence of one or two fistulae, and a large amount of 
pus escaping from them. A necrotic center is soon formed ; by infection 
of surrounding parts, the disease spreads gradually ; the weak vascularity of 
the tendinous tissue, the density of its structure, and its slow vitality render 
the entire separation of the slough very difificult. 

This affection always admits of a strict prognosis ; it may, however, 
vary with some circumstances. The necrosis of the anterior extensor of 
the phalanges is much less severe than that of the flexors, and among those 
the lesions of the perforans are the most dangerous. Whatever be the organ 
affected, the disease is so much the more alarming as it is located nearer 
to the hoof ; and also one must always count upon possible complications, 
especially bony lesions, synovitis and arthritis. The necrotic lesions of 
the metacarpal sheath and the bands of the aponeurosis of the perforans 
and of the plantar cushion are less serious than true tendinous quittor — at 
least they give rise to less lameness and less pain than tendinous quittor. 

When tendinous quittor exists with all the conditions for its development, 
it may nevertheless in some cases be arrested. Cutaneous quittors treated 
antiseptically (baths, damp compresses and wadded dressings) rarely be- 
come complicated. If the case is neglected, the dividing fissure between 
the slough and the healthy tissues spreads deeply, the pus reaches the 
tendons, remains on their surface and often starts a partial necrosis. 
Peri-tendinous abscesses must be opened early, disinfected and drained. 
In suppurative synovitis tendinous alterations are also prevented by free 
cuttings and antiseptic treatment. We have already stated how wounds 
of tendons are to be treated. (See Tendinous Wounds^ 

For tendinous quittor itself, several therapeutical methods are offered. 
Let us mention only to condemn the method of treatment in which poultices 
or warm compresses are applied to the diseased region without a free opening 
first of the fistulse. Some practitioners have recourse still to this method ; 
but it is insufficient and dangerous. It does not arrest the necrosis, 
but gives exposure to the most serious complications. 

To assist the flow of the pus and insure the action of the medical 
agents as directly as possible upon the diseased parts are the rules common 
to all cases. The direction and the situation of the fistulae should be 
carefully noticed. Some are deep, undermining, and the pus filtrates 



294 VETERINARY SURGICAL THERAPEUTICS. 

along the tendons and collects in a large cul-de-sac ; the tracts must be 
enlarged, the pus given free escape, painful pressures relieved and the 
necrosed tendinous part freely exposed or removed. Incisions should be 
made parallel to the axis of the leg, avoiding the blood vessels and nerves ; 
the fistulae should be curetted and the purulent pouches disinfected with 
antiseptic washes. Should profuse hemorrhage occur, plugging with iodo- 
formed dressing should be applied. 

The therapeutic agents recommended have varied with the various epochs 
of their introduction. Actual cautery to a white heat, applied on the mor- 
tified tendinous part, has given and yet gives good results : it modifies 
the putrid into an aseptic eschar, and the surrounding tendinous tissue 
may remain free from infection and recovery may take place. But this 
process is not sufficiently sure ; the cauterization is either too much or 
not enough ; and often the necrosis keeps on, even after an extensive 
slough has taken place. Among the caustics used in the first two-thirds 
of this century, corrosive sublimate, in powder or in pencil, introduced 
into the fistulae, arsenious acid, nitrate of silver, and sulphate of copper 
have been recommended. 

A large number of liquid, caustic or disinfecting preparations have 
been recommended for tendinous quittor. Two among these — VilJate 
solution and tincture of iodine — have proved themselves especially ad- 
vantageous, and they are still extensively used. When injected several 
times a day into the bottom of the fistulae, at the same time carefully 
preventing contraction of these by the introduction of tents or plugs, they 
have often brought on recoveries. With baths ot sulphate of copper, 4 
to 6 in 100, repeated twice a day, Rey and many others have obtained 
excellent results. The great objection to very strong solutions is that 
they have too powerful an escharotic effect on the skin of the soaked re- 
gions. Aureggio has advised the use of glycerine. Carried into the focus 
of the necrosis, it may, like the preceding agents, clean off the fistulge, 
the undermined spaces, and the exfoliated part of the tendon. 

Antiseptic treatment is to-day preferred to hydrotherapeutics. Iodo- 
form, in powder or united with vaseline or glycerine, has proved itself very 
active. We have used it with great advantage. More or less concentrated 
solutions of corrosive sublimate are also precious agents. They are used 
in strength of i in 1000, i in 500, or i in 100 (water 100, glycerine 10, 
corrosive sublimate i). At present tendinous necrosis is especially treated 
with antiseptic liquids. Free incision, drainage, antisepsis, is the formula. 
Often in the course of the disease, when synovitis complicates tenositis, 
abscesses have to be punctured, counter-openings are to be made and 
new drains applied. If the antiseptic irrigations are well done, little by 
little the suppurations will become less abundant, the pus will change 



TENDINOUS RUPTURES. 295 

aspect, the indurations and the sensibiUty diminish, the pain subside, the 
rest of the leg be better, and the fistulae close. But tendinous quittor is 
obstinate. Sometimes the treatment demands six weeks or two months. 
For lesions of the bands of the plantar cushion, or the bands of in- 
sertion of the strengthening aponeurosis of the perforans, or those of the 
metacarpo phalangeal sheath, the directions are the same. 

When once recovery is brought about, generally the organs of the region 
are united by inflammatory induration ; when the quittor has involved the 
flexors, the great sesamoid sheath has disappeared, the tendons are ankylosed 
and their action greatly hindered. With exercise, baths and massage, 
these disorders may gradually subside. In a number of cases, when the 
acute inflammatory phenomena have subsided, cauterization with deep 
points or with needles made on the diseased part will hasten the absorp- 
tion of the induration. If the remaining lesions are such that lameness is 
persistent, median or sciatic neurotomy is to be prescribed. 

But the termination is not always so good. Sometimes during the 
disease serious accidents may occur. The diseased leg being unable to 
carry its part of the weight of the body, its congener, overloaded, is ex- 
posed to laminitis. With tendinous necrosis, suppurative synovitis, bony 
necrosis and arthritis may make their appearance. A time arrives when, 
emaciated and exhausted by pain, the patient remains continually lying 
down, dry gangrene of the skin occurs in patches, and the animal has 
to be destroyed. Also, in cases of purulent infiltrations, pyohaemic symp- 
toms manifest themselves and soon carry off the poor suffering beast. 

IV. 

TENDINOUS RUPTURES (BREAKINGS). 

Tendinous ruptures, partial or total, are generally the result of violent 
muscular efforts. At times there is a special predisposition or an altera- 
tion of the tendinous tissue which promotes the rupture : thus are ex- 
plained the facts of multiple ruptures observed in a single subject. 
Rheumatism, simple, chronic, or suppurative tenositis and the navicular 
disease seem to be the most frequent causes of the softening of tendons. 
Moller and several other authors have reported cases in horses of ruptures of 
the four perforans tendons. To Braiier is due the following curious record : 
In a horse suffering from anasarca and kept in absolute quiet for a cer- 
tain length of time, the flexor tendons of the phalanges had become so 
elongated that the fetlocks rested almost on the ground ; the animal walked 
like a plantigrade ; the tendons and peri-tendinous tissues were neither 
tumefied nor painful ; after four months the tendons had returned to 
their original dimensions, the legs recovered their normal standing and the 
horse was able to return to its work. Numerous facts, however, show 



296 VETERIxNARY SURGICAL THERAPEUTICS. 

that a violent muscular contraction may produce the rupture of a sound 
tendon. 

Thirty-four observations of tendinous ruptures recorded by St. Cyr 
in 1854 are classified as follows : Cord of the flexor metatarsi, 21 cases; 
flexors of the foot, 10 ; suspensory ligament, i ; tendo Achillis, i ; an- 
terior extensor of the phalanges, i. Many observations gathered from all 
the clinics can to-day be added to this list. 

Though the paratendinous connective tissue co-operates like the tendon 
itself to the cicatrization of complete or incomplete ruptures generally, 
the prognosis is serious. With tendons of the extremities it is sometimes 
advantageous to destroy the animals at once. If the lesion is protected 
from the air repairs will take place regularly, but months must pass be- 
fore the leg is again useful. Injuries of the flexor tendons are more seri- 
ous than of the extensors. If suppuration occurs necrosis of the tendon 
is to be feared, and the prognosis is still more serious. 

The treatment of tendinous ruptures demands three principal precau- 
tions : (i) Give to the leg the position in which the ends of the tendon 
are closest to each other ; (2) insure the steadiness of the parts by a 
special apparatus or solid bandage of plaster or pitch ; (3) give the animal 
a long rest. Treatment is justified only when the rupture is free from 
previous degenerations. After recovery the tendon is generally elongated 
and locomotion more or less interfered with. In time these are remedied 
and perfect health returns. Here again the ideal form of treatment 
would be to expose the traumatic center and sew up the stumps of ten- 
dons. For certain tendons, if the operation were performed aseplically 
and completed with a plaster dressing or a special apparatus, it might 
give good results. A few attempts have been made in this direction, but 
up to this time have proved unsuccessful. 

SPECIAL TENDINOUS RUPTURES. 

/. — Tendoti of the Infra-Spinatus. 

This, though extremely rare, has been observed by Bouley at the Alfort 
Clinic, on two horses cast for surgical purposes." It was characterized 
" by a marked deviation of the scapula and humerus at their point of 
juncture. When the leg was put down, both bones made an angle pro- 
jecting well outwards." 

Bouley says one need not worry much over the seriousness of the 
accident. Place the animal in a sling, and apply a blister over the part, is 
the treatment required. The union of the two ends cannot but take 
place, 

1 Bouley, Bullet. Soc. Cent. Med. Vet. 1864, p. 392. 



TENDINOUS RUPTURES. 297 

The rupture of this tendon is always possible, but it is principally 
produced by any violent traumatic action applied on the shoulder, on a 
level with the tendon. We may remark that the two cases reported by 
Bouley were more likely to be paralysis of the sus-scapular nerve, than 
lesion of the tendons. The functional troubles described were those of 
such paralysis, and no local symptoms are described which must have been 
present, if there was a tendinous lesion. The result of the experimental 
section of the tendon, made to confirm Bouley's diagnosis, does not prove 
it ; both section and paralysis being accompanied with the same symptoms. 

//. — Cord of the Flexor Metatarsi. 

Of all tendinous ruptures, this is the most frequent and the most 
studied. The ordinary causes of the accident and the troubles that it 
produces are well indicated by Solleysel. " From a struggle while in 
stocks, from an effort while being shod or in going down a very steep hill, 
from fall, or from being entangled under a heavy load, the big tieti'e of 
the hock may stretch and twist with so great a force, that it becomes soft 
and relaxed as a loose cord ; 7uheii the animal walks, the leg hangs on the 
hock, loose, as if it were suspended. One might believe that the bone is 
fractured, so greatly is the action of the leg different from the normal ; 
when the animal rests its foot upon the ground and the hock is extended 
to its natural extent, the standing of the foot is good ; there seems to be 
but little or nothing out of the way." 

Although Solleysel well indicated the causes and symptoms of this 
affection, he was ignorant of its nature ; for he thought the lesion con- 
sisted in a stretching and elongation of the tendon Achilles. The observa- 
tions of Barthelemy, Bouley, Jr., and Renault have since explained the 
character and the diagnosis. Rigot explained the mechanism of the 
accident by experimental sections of the cord of the flexor metatarsi. 
Vatel, Feslat and Furlanetto have recorded observations in the case 
of cattle. 

The rupture of the tibio-pre-metatarsal muscle takes place at various 
points of its length; sometimes at its femoral insertion, between the 
external condyle and corresponding border of the femoral trochlea 
(Goubaux). When the rupture of the cord takes place in the tibial 
region, the ends of it, immobilized by the muscular layers between which 
they are inclosed, readily cicatrize ; when it takes place at the superior 
extremity of the muscle, the continual motions of the point prevent 
cicatrization. 

If an animal thus affected is made to walk, the femoro- metatarsal cord, 
not transmitting to the canon the flexion of the femur, and the fleshy 
portion of the muscle being powerless in taking its place, the canon is no 



298 



VETERINARY SURGICAL THERAPEUTICS. 



longer flexed on the shank, and remains powerless below it, the phalangeal 
column hangs vertically or in very slight flexion. The foot is raised from 
the ground, like that of the sound leg ; at times only, the toe touches the 
ground. The tendon Achilles, no longer subject to the counteraction of the 
flexor muscles, is flabby, shrunk, perhaps bent in two in the middle or 
near its insertion into the os calcis (fig. 70). By carrying the canon bone 
backwards, one may succeed in placing the shank, the hock and meta- 




Fig. 70. — Rupture of the cord of the flexor-metatarsi. 
(From a photograph.) 

tarsus on a straight line, which made Louchard say that " it looks like a 
complete luxation of the hock. " 

When at rest, everything is changed ; no matter how serious were the 
symptoms exhibited while the animal was walking, they have disappeared : 
the leg, which a moment before was powerless, participates now in the 
support with the entire inferior face of the foot. The severe prognosis 
made must be modified. 

^Vhen the accident is the result of a blow on the anterior face of the 



TENDINOUS RUPTURES. ^99 

tibia, or if with the rupture of the cord there is partial laceration of the 
muscle with a more or less abundant bloody exudation, the anterior face of 
the tibia presents either a wound, or only a tender, oedematous part; the 
inferior part of the leg may be the seat of a swelling, more or less promi- 
nent. But when the rupture is the result of a forced extension of the leg, 
it keeps its normal clean appearance. In both cases, the symptoms 
observed during walking are characteristics and the diagnosis is easy. The 
exploration of the leg will always permit one to avoid the error of Barthe- 
lemy, who believed that it was a case of fracture of the tibia.' 

In this rupture, the ends of the divided cord do not spread apart very 
much, the treatment is very simple, and complete recovery is the general 
rule. The animal must be left in absolute rest, loose in a box-stall. To 
put splints and a pitch bandage on it, as did Solleysel, is useless. Emol- 
lients, douches and padded dressings have been recommended. A rest of 
four to five weeks is sufficient to obtain a recovery, both ends of the cord 
uniting spontaneously. Vesicating applications are not necessary, though 
they accelerate the repairing process ; the local pain that they produce in- 
sures the more complete immobilization of the leg, and while the leg is 
covered with the crusts of the blister, the owner is more willing to leave 
the animal at rest. As it is not always possible to find the spot of the 

1 In a series of experiments which we have made, we have observed a differ- 
ence in the symptoms. In one case where we divided the tendon only a little 
below its passage through the groove between the external and anterior tuberos- 
ity of the superior extremity of the tibia, the animal showed all the manifesta- 
tions observed in all similar cases I had observed, at once. In a second case, 
where we had divided the muscular portion only, we observed that when the 
horse walked away from the bed, his action was perfect, the leg being carried 
away without trouble, the hock well flexed. In a third experiment, an incision 
was made just above the tibio-tarsal joint, the tendon of the anterior extensor 
pedis well isolated and then the entire structure of the muscle, which is there 
mostly tendinous, was divided. Immediately the animal drags his toe with 
much difficulty, knuckles considerably at every step he takes ; the tendon 
Achilles is more marked than in the subject of the first experiment. When the 
animal is turned round on the operated side the action is more difficult, the leg 
is carried more in adduction. Still the standing is firm on both legs and when 
in his stall the animal seems in perfect health. 

From these experiments I concluded (i) the rupture of the fleshy portion 
alone of the flexor metatarsi will not give rise to the symptoms of the cases 
recorded ; (2) rupture, laceration or division of the tendinous portion alone in 
the upper part, from its origin to the point of union with the muscular fibres, 
will give rise to the difficulty of flexion at the hock ; (3) rupture or division 
of the lower portion of the muscle or of any part of the nniscle where tendon 
and muscle are united, will also give rise to the same symptoms, but probably 
more marked, with greater difficulty of flexion at the hock and impaired coor« 
dination of the movements,— (Anier. Vet. Rev., vol, 3, page 263.) 



300 VETERINARY SURGICAL THERAPEUTICS. 

rupture, a blistering application is often put the entire length of the tibial 
region. It is rare that permanent difficulties of locomotion would follow. 
SoUeysel has said : " Horses are able to perform their work afterwards as 
before ; but it takes more than one day." Before return to work, it is 
important that both divided ends of the cord shall be strongly united by 
cicatricial tissue. 

We have said that the ordinary termination is complete recovery, yet 
there are cases in which it is not obtained. In an observation of Vatel, 
the rupture, which had taken place at the upper part of the tibia, was fol- 
lowed by an irregular repair in the trauma, with adhesion of the cord to 
the bone of the leg and atrophy of the anterior extensor of the phalanges 
and muscular portion of the flexor ; the animal had to be destroyed after 
seven months of treatment, lameness remaining all the time. Bouley has 
met with several failures. In one horse treated by us for a rupture which 
had taken place near the superior insertion of the tendon, there was no 
flexion of the canon, even after four months. This trouble gradually sub- 
sided but did not disappear entirely. These cases are, however, excep- 
tions. 

Festal has obtained a complete recovery in twenty and thirty days in 
the case of cattle. 

///. — Tcndon-Achilles. 

The rupture of this tendon may take place at various points, sometimes 
at the very origin of the tendon. At times it is primary and occurs on a 
sound tendon ; at others it is preceded by changes in the tendinous tissue. 
Uhlich has seen it in a horse after influenza.' Schrader found in a cow the 
tendon ruptured on both legs. Most commonly it is primary and affects 
but one leg, and is the result of external violence or powerful effort. The 
observation of Vatel refers to a young goat, which, having jumped from a 
third-story window, ruptured the cord of the hock ; the two ends were 
four centimeters apart. The leg was kept six weeks in extension by 
splints and bandages, and recovery was perfect.^ 

For all kinds of valuable animals, treatment may be attempted if the 
lesions are not too serious. With small patients, one may, as Vatel did, 
place the leg in extension and hold it there with bandage. The dressing 
recommended by Detroye for fracture of the calcaneum may be used for 

1 In the case of Schreibler, House Surgeon to the Hospital Department of the 
American Veterinary College, a dog had struck one of the barbs of a wire 
fence and severed the tendon Achilles. The separated ends of the tendon were 
one inch apart. The leg was put in splints and recovery occurred in four 
weeks.— (Amer. Vet. R£v., vol. 9, page 467.) 



TENDINOUS RUPTURES. 30I 

large animals, but it is wise to keep the animal in slings. (See Wounds 
0/ the Cord pf the Hoik^ In the case of a horse, recovery has been ob- 
tained in two months by Martens, in two months and a half by Griiner. 

IV. — Anterior Extensor of the Phalanges. 

Rupture of this is frequently congenital. In Knoll's observation, it is a 
colt two days old, which had, on the right forearm, a rupture of the fleshy 
portion of the muscle, and on the left leg, a rupture of the tendon of the 
same muscle. Chassaing has often observed the same trouble in new-born 
subjects. The rupture may be complete or incomplete, exist on one or 
both legs. Generally, it takes place on a level with the knee. If com- 
plete, the patient cannot stand up ; and in front of the joint two round 
little tumors are felt a few centimeters apart from each other ; they are 
the ends of the tendon. In incomplete rupture, standing is almost impos- 
sible. At the post-mortem examination of several animals, Chassaing 
found, on a level with the carpal sheath, the tendon thinned down to half 
its thickness, or the two tendinous stumps completely separated. In all 
the cases the sheath was inflamed, and contained more or less synovia. 
When the rupture was complete, all forms of treatment were useless. 
Partial lacerations recovered by immobilization or simple friction with cam- 
phorated alcohol. In a thirteen year old horse, Gavard observed, on 
the left fore leg, a partial rupture of the tendon of the extensor, occurring 
after a mis-step of the animal. In walking the digit remained flexed on 
the canon, and rested for its support on the toe or the anterior face of the 
foot. There was great pain in front of the fetlock and a peculiar soften- 
ing of that part. At the post-mortem examination the tendon was found 
thinned and degenerated. 

Immobilization and cold to allay the inflammatory phenomena, and later 
blisters, are sufficient for the recovery of a healthy tendon. 

V. — Flexors of the Phalafiges. 

The rupture of the tendons of the flexors of the phalanges is an accident 
quite frequent. Already in 1854, St. Cyr, in his memoirs, reported ten 
observations. Since then a number of others have been recorded. 

Although, sometimes, as proved by the case of Rodel, rupture of this 
tendon may occur, when it is healthy, as a result of violent actions, it is, 
nevertheless, most commonly due to degenerative changes, and to soften- 
ing brought on by chronic phlegmasia, rheumatism, tendinous quittor 
Leblanc, Saint-Cyr), synovitis (Patter), necrosis of the plantar aponeuro- 
sis from punctured wounds (Rey, Saint-Cyr), navicular disease and plantar 
neurotomy (Renault, Beaugnot, Mollereau). In injured horses, whose 
anterior quarters were supj:iorted by only one leg, Serres saw this leg be- 



302 



VETERINARY SURGICAL THERAPEUTICS. 



come the seat of a swelling, first localized on the fetlock, then spreading 
to the coronet, and upwards to the knee. After a while, if treatment was 
not applied, the fetlock would drop down, while the locomotion and spe- 
cial symptoms would be those of ruptured tendons ; such as rest on the 
posterior part of the plantar surface or on the ergot, toe of the foot 
becoming horizontal, and inferior face of the foot perpendicular, to the 
ground. Upon ponies from Anam that were used by French soldiers in 
the extreme East, Ballu and Gillet have observed, on the hind legs 
especially, numerous cases of ruptures of tendons, of the suspensory liga- 




Fig. 71. Rupture of the tendons of the flexors of the phalanges. (From a 
photograph.) 

ment, and of the sesamoid ligaments ; accidents which seemed to have 
been prepared by a " hypergemic " condition of these organs. In these 
cases, however, it is possible that they were only sudden ruptures of sound 
tendons, due to the enormous load carried by these little animals, or rup- 
tures which were also promoted by the formation of their hind quarters, 
and the bad condition of the roads over which they traveled.' 

^ The trouble is quite common in America and many veterinarians have re- 
corded cases relating to it. Among the many is that of Dr. R. Kay, where the 
perforans tendon and the sesamoid ligaments of three legs of a gelding were 
successively affected,— (Amer. Vet. Rev., vol, 8, page 234.) 



'TENDINOUS RUPTURES. 303 

The symptomatic manifestations vary In their severity, as the rupture is 
simple or double, complete or incomplete ; when both tendons are divided, 
they are very marked. Most commonly the tendon gives way below the 
fetlock, in the fold of the coronet, and sometimes on a level with the 
metacarpo phalangeal joint. 

Whatever the location, complete rupture is always clearly marked by the 
dropping of the fetlock (fig. 71). 

For horses suffering with a severe lesion of an anterior extremity so that 
they have only one sound fore leg for support, Serres recommended the 
reclining position or suspension in a sling, thus avoiding the softening of 
the flexor tendons. It would also be advantageous to envelop the sound 
leg from the foot to the knee in cold water bandage or compress. 

In incomplete ruptures, difficult to diagnose (Degives), immobilization 
with a bandage is an important measure, and is, ordinarily, sufficient to 
bring on recovery. 

Complete rupture is, generally, an incurable lesion demanding that the 
animal should be destroyed, since, in the majority of cases, extremely 
serious complications accompany it (chronic tendinitis, tendinous quittor, 
synovitis, navicular disease). In Mollereau's horse, both sesamoid sheaths 
were inflamed and the tendons softened ; the tendinous and ligamentous 
apparatus of the metacarpo-phalangeal and interphalangeal joints showed 
marks of high inflammation with advanced softening of the tissues; 
the perforans was diseased from the fetlock to the semi-lunar crest ; the 
lesions increased in severity from upwards downwards, as far as the sesa- 
moid sheath. The tendinous tissue was, as it were, dissociated, broken 
up into its constituent fibres ; it was purple in color, with numerous ecchy- 
motic spots here and there on its front face and through its substance. 
The same lesions existed on the semi-lunar crest. 

Interference is only proper in cases where the structure is not altered in 
accidental rupture. According to Rodet, this is not a rare occurrence on 
the hind legs " from violent efforts to overcome an obstacle or from a rapid 
gait." 

The treatment then requires the application of a special apparatus or 
an immovable bandage to prevent the dropping backward of the fetlock. 
(See IVoutuis of the Flexor Tendons.) 

VI. — Suspensory Ligament. 

The investigations of Barrier and Poy have shown that the suspensory 
ligament is frequently the seat of lacerations. Therefore it is not surpris- 
ing that it may be ruptured. Examples are not very rare (Goubaux). 
Saint-Cyr records the following ; 



304 VETERINARY SURGICAL THERAPEUTICS. 

" A horse having been harnessed to a truck loaded with stones, and the 
axle breaking, the animal fell down under the great weight. When it got 
up, it was unable to rest on its foreleg ; the digital region bent forward, 
even when not in motion, and the animal rested with the posterior part of 
the fetlock down ; but there was no swelling, and no local pain." The 
animal however, was destroyed, because it was found that the suspensory 
ligament was completely ruptured a little above its point of bifurcation. 

In the case of Dubos, " the superior parts of the two sesamoids were 
broken and the separated portions remained adherent to the extremities of 
the suspensory ligaments." 

Comeny's mare showed general manifestations of great suffering and had 
her front legs stretched stiffly forward. " The hind legs were brought 
under the body, as in laminitis ; the front fetlocks could be seen dropping 
and rising alternately, according as each was called upon to carry the 
weight of the body. The rest on one leg was for a very short time and 
for that time the ergot touched the ground and the metacarpo-phalangeal 
angle measured less than 90°. In walking the symptoms were still more 
marked. 

At the post-mortem examination, a rupture of the two branches of both 
suspensory ligaments was found, with lacerations of the lateral metacarpo- 
phalangeal ligaments, extensive secondary lesions of the sesamoid sheath, 
arthritis of the fetlock, periostosis and fractures of both small metacarpal 
bones. 

Such lesions on the two front legs are incurable. With one leg only 
treatment may be attempted. By supporting the fetlock behind with 
a plaster bandage, the apparatus of Defays, or special shoeing, the tendi- 
nous ends might unite. A rest of six weeks to two months would be 
required. 

Firing of the whole region, should it be too indurated, might complete 
the treatment. 

V. 
TENDINOUS LUXATIONS. 

Those are very rare in all animal species. The horse has presented the 
most interesting examples. Most of them have to do with luxation of the 
perforatus of the hind leg ; a few with that of the tendon of the posteo- 
spinatus. 

The liixatio7i of the perforatus, in the calcaneal portion, has been ob- 
served by Goubaux, Trelut, Burck, Drouet, Fourie, Le Calve', Stockfleth, 
Gunther, Moller and Bayer. 

It may take place inwards or outwards. The horse treated by Trelut 



TENDINOUS LUXATIONS. 305 

had kicked backwards violently, and, in dropping to the ground, had 
struck on the left hip, and nearly fallen. When he got up, it was observed 
that the hock was considerably flexed, nearly touching the ground. On 
the inner face of the tibio-tarsal joint, the hand felt a strong cord, which 
was easily pulled back over the point of the os calcis, allowing the hock 
then to resume its shape and proper position. There was no doubt that 
it was a luxation of the perforatus tendon. Though the reduction was 
simple, all means to hold it in place were useless. The author " bled the 
animal repeatedly to allay the inflammation and the enormous swelling of 
the leg." Forty days after the accident, the animal was able to resume 
his work as a stallion. " At the end of the season, the tarsal arch was 
filled with a thick cord, formed by the dislocated tendon surrounded by 
tissue of new formation ; the animal was able to work, but the hock always 
remained weak." ^ 

The patients of Burck, Drouet, Fourie and Le Calve had a luxation on 
the outside of the hock. Instead of the motion noted in the preceding 
case during locomotion, the hock remained extended and the foot touched 
the ground. The tendinous cord was easily put back into place, but the 
luxation would return as soon as the hand was taken away. Burck had a 
leather boot made for his case, but it would not remain in place : he 
then blistered the hock on both sides. " The reduction took place of 
itself after six weeks of rest in the hospital, and the lameness disappeared." " 
Another horse recovered in the same way, without return of the trouble. 
Drouet says : " It seems to me rational, before using revulsive medication, 
to secure artificially, by a subcutaneous suture involving the bone and the 
tendon, the calcaneal cap of the tendon over the apex of the os calcis and 
then to immobilize the parts as well as possible." ^ Our colleague did 
not try the operation ; the patient, being too old, was destroyed. In the 
horse of Fourie and Le Calv6, the leg was swollen from the foot to the 
hock. A mixture of blister and mercurial ointment was applied, followed 
by another a week later. Two weeks after the accident, the animal walked 
easier, though with difficulty. The flexion was jerky and at the time of 
rest all the inferior part of the leg, from the hock down, rotated from in- 
wards outwards. The animal rested his foot on the toe and on the internal 
quarter. 

To be niore beneficial, the treatment should secure the perforatus in good 
position. The suture recommended by Drouet demands a delicate technic 
and may involve serious accidents if the asepsy is not perfect. In case it 
should be made, it would be necessary to relieve the hock from the carry- 

1 Trelut.— Journ. des Vet. du Midi, 1865, p. 4S6. 

2 Burck. — Recueil de Med. Vet., 1892, p. 341. 

3 Drouet. — Journ. de Med. Vet. 1S92, p. 6S4. 
20 



306 VETERINARY SURGICAL THERAPEUTICS. 

ing weight when the annual is at rest by the use of strong splints or by the 
apparatus of Relier. In that region, no suture will resist the weight of 
the body. In the majority of cases, a blistering friction on both faces of 
the hock will be proper; the walking, difificult at first, will regulate itself 
later ; after six weeks or two months, light work will be possible. 

Guittard and Furlanetto have observed in cattle the displacement of the 
tendon of the infraspinatus. To take place, such accident requires the 
rupture of the synovia and of the fibrous bands which hold it over the 
torochiter. In the patients treated by Guittard, the moving of the cord 
was little shown, the flexion taking place in two steps ; the walking was 
difficult and the movements of the leg slow and hesitating. In the obser- 
vation of Furlanetto, the accident had occurred on both legs after a violent 
effort. At rest, no symptom indicated the injury, but when the animal 
raised the leg, the tendon could be seen slipping backwards from the 
trochiterian convexity; this displacement could also be produced with 
pressure by the hand. Absolute rest and repeated blistering frictions 
were followed by recovery in a month. 

VI. 

SPRAINS OF TENDONS.— NERF-F£RURE.—TEN0SITIS. 

Produced by powerful muscular contractions, by efforts which stretch the 
tendinous cords and rupture more or less a great number of their constitu- 
ting fibres, this affection, observed in all animals used as motors, is very 
common in horses. Though a great number of tendons may be " forced," 
the denomination of sprain (effort) of tendons is applied, in ordinary lan- 
guage, to lesions of this kind which involve the tendons of the flexors of 
the phalanges, their reenforcing bands and the suspensory ligament. 

The general belief, that old hippiatres did not know the true effort of 
tendons, is erroneous. Lafosse, in his Dictionary, recognizes: (i) the 
tendinous alterations produced by bruises (the nerf-ferure) ; (2) the 
extension of the tendon, the " distension of its fibres " occurring outside of 
all traumatism, during the actions of locomotion. But there was an 
error made in relation to the frequency of the tendinous lesions resulting 
from traumatic causes ; in most cases, indeed, the subcutaneous inflam- 
mations of the tendons of the flexors of the foot have for cause an effort, 
and not a bruise of the tendons. 

To the expression of " nerf-fe'rure," used then to designate the lesions 
which were believed to be of traumatic nature, a wider denomination has 
been given, which has been confirmed by use. Indeed to-day both ex- 
pressions are indifferently employed. 



SPRAINS OF TENDONS.— NERF-FERURE.—TENOSITIS. 307 

For a long time, in classical language, " powerful and repeated efforts 
of locomotion " were mentioned as causes of those injuries. The mode 
of action of these causes has been closely studied of late by Barrier and 
Siedamgrotzky. With the assistance of instantaneous chromo-photographs 
taken in series, these authors have given a new pathology of the altera- 
tions of the disease. It is summarized as follows : 

Let us suppose a leg, in which the metacarpal and phalangeal levers 
flex normally : at the moment when the leg in motion comes to the 
ground, the phalanges are in the long axis of the canon ; as soon as the 
resting of the foot to the ground takes place, the phalangeal lever, formed 
by the first and second pasterns, operates a movement of flexion upon the 
immobile hoof, which has for effect to bring closer to each other the 
semi-lunar crest and the sesamoid pulley, and also to relax the perforans. 
A slight flexion of the first phalange also takes place on the second, con- 
tributing to the relaxation of the perforatus and of the perforans. The 
fetlock, no longer supported by the tendons, drops, the sesamoid pulley 
slides over the anterior face of the deep flexor, and at this moment the 
suspensory ligament is alone preventing the dropping of the fetlock back- 
wards. If the reactions are powerful, or if the suspensory ligament is 
diseased, it may tear. When a slight downward motion takes place, the 
perforatus comes to the assistance of the suspensor ; and, for Barrier and 
Siedamgrotzky, the lesions of the superficial flexor takes place at the first 
step of the rest of the foot on the ground. On the contrary, the perfor- 
ans, more relaxed, is seldom lacerated. But at the time preceding the 
raising of the foot, when the leg is in hyperextension, the angle of the fet- 
lock is bent forward, the phalanges become upright, the canon is oblique 
from forward backward, the perforans is powerfully stretched by the pro- 
jecting behind of the sesamoid and glenoid pulleys, and it is the less 
resisting — the reenfoixing hand {la bride) — which generally gives way. 

It is shown that, according to the new theory, the suspensory ligament 
and the perforatus are liable to injuries at the beginning of the period of 
rest of the foot, while it is the perforans and its reenforcing bands, the 
lateral ligament of the phalangeal joints, the digital ligaments, which are 
threatened at the end of the rest, when the leg ready to leave the ground 
is in hyperextension. Barrier has specially insisted upon the secondary 
" nei-f -fern res y He has shown that the false ankylosis of the first and 
second interphalangeal articulations predispose to the lesions of the per- 
forans, of the carpal and tarsal bands and of the perforatus ; with Petit, 
he has observed that the chronic great sesamoideal synovitis, in prevent- 
ing the functions of the pedal pulley, brings on atrophical lesions of the 
perforans, well accused, and, by that alone, predisposes to the disease of 
the perforatus. In fact, the lesions of the carpal band occur frequently 



?o8 



VETERINARY SURGICAL THERAPEUTICS. 



•with phalangeal periostosis, which seem to have existed before them. 
But the primitive " neff-/erure" is often observed in animals with rapid 
gait, whose phalangeal structure is free from lesion. In these animals, it 
is exclusively produced by the excessive distension of the tendinous cords 
under the action of the weight of the body and with the force of the im- 
pression. And if phalangeal periostosis predisposes to " nerf-ferure," 
the latter predisposes to the former. 

In a paper presented in 1844, before the Soci^t^ Centrale de Medecine 
Vet^rinaire, Prudhomme, from a number of observations gathered at the 

Alfort clinics, defended the statement 
that the carpal band was affected 
in two-thirds of the cases, and that the 
tendinous lesions were observed only in 
the other third. Bouley and all of his 
day accepted the opinion of Prudhomme. 
For them, the suspensory ligament 
was never afifected, on account of its 
great elasticity. It was said that, 
when the leg returns to rest on the 
ground, the force, representing the 
weight of the body, transmitted to the 
summit of the os suffraginis had for 
result to lower the phalangeal lever; 
the suspensory ligament, very elastic, 
thanks to the muscular fibres that it 
contains, could yield without being 
injured ; but the tendons, inextensible, 
would tear if the reactions were too 
powerful, and the thinner band, less 
resisting than the tendons, would be 
most frequently injured. Carefully 
studied observations (Barrier, Siedam- 
grotzky, Com^ny, Jacoulet, Poy) have 
shown that the alterations of the sus- 
pensory ligament are not as rare as 
they were thought to be. Indeed, 
the lesions of " nerf-f^rure " may occur 
in all the desmo-tendinous parts of the cannon, fetlock, and coronet — that is^ 
upon the suspensory ligament, the perforans, perforatus, the carpal, tarsal 
radial and calcanean bands, the metacarpo-phalangeal sheath, the reen- 
forcing bands sent by the suspensory ligament to the anterior extensor of 
the phalanges, the inferior sesamoid ligaments, the inserting branches of 




Fig. 72. — Suspensory ligament, car 
pal band, perforans and perforatus. 



SPRAINS OF TENDONS. — NERF-FERURE. — TENOSITIS. 309 

the glenoid cartilage, the reenforcing aponeurosis of the perforans 
(fig. 72). 

Which of these lesions is most frequent ? We have just seen the pro- 
portion mentioned by Prudhomme. According to Siedamgrotzky, the 
lesions of the carpal band are far the most common. Out of eleven cases, 
Barrier has found five on the suspensory ligament. According to Jacoulet 
and Poy, this ligament would be diseased in 50 per cent, of the cases, 
while the carpal band would be only in 12 percent. (Poy). The great 
difference between these figures is due to numerous conditions, specially 
to the difference of conformation and work of the animals under the ob- 
servation of those authors. The professor from Dresden insisted on that 
point. He has shown that the lesions of the suspensor and of the inferior 
sesamoid were met specially in saddle, hunting or steeple-chase horses and 
in fast trotters. Long and weak pasterns, high heels, high heeled shoes, 
high action, fast gait with heavy load, misteps, jumps— all of those favor 
their development. Alterations of the perforans, of the carpal band, of 
the ligaments and bands of the fetlock and coronet are more particularly 
seen in heavy draught horses, exposed to violent and sudden hyperexten- 
sions. Low heels, feet improperly pared, work on uneven ground, and 
heavy loads predispose to them. This we observed in our clinics at 
Alfort among the draught horses which form the best part of our patients ; 
as in the days of Prudhomme, lesions of the carpal band are those that we 
have most commonly to treat. But if the carpal band and the reenforcing 
aponeurosis are more commonly affected than the deep flexor, the lacera- 
tions of this tendon are not rare. According to Siedamgrotzky, they most 
commonly occur between the sesamoid pulley and the glenoid cartilage ; 
they are due to the chronic inflammation of the sesamoid, carpal or tarsal 
sheath. Barrier, on the contrary, sees specially in those alterations of the 
deep flexor, atrophic and degenerating lesions, due to chronic synovitis. 
The frequency of the primitive lesion of the perforans is not doubtful ; 
however, in many instances, those lesions of the perforans seem to be 
brought on by primary synovitis, which prevents the action of the sesamoid 
pulley. 

Let us add, however, that all phlegmasies of the flexor tendons do not 
follow efforts or traumatisms. No more than others, tendinous tissue is 
not exempt from inflammatory process of infectious origin (pneumonia, 
influenza, rheumatism). 

The synnptoms of " nerf-f^rure " are generally well marked. At times 
the swelling is large, diffuse, involving the whole leg; at others it is 
limited to a portion of the tendon or of the carpal band ; there are cases 
where in one day it assumes large dimensions (hemorrhage or extensive 



310 VETERINARY SURGICAL THERAPEUTICS. 

peri-tendinous infiltration). Tlie seat, dimensions, and condition of the 
levelling permit the recognition of the locality of the disease. All that is 
necessary is positive anatomical knowledge of the parts. 

The prognosis, always serious and often very much so, varies with the 
situation, extent, and serosity of the lesions. Sprains of the suspensory 
ligament or of the perforatus are less serious than those of the perforans 
or carpal band. With complete rupture of the suspensory, recovery may 
be sufficiently perfect to permit the animal to resume work. When the 
perforans and its band are simultaneously affected, the prognosis is very 
serious. Distension, with or without tearing of the metacarpo-phalangeal 
sheath, gets well almost always; the line of the tendons remains irregular, 
but the lameness disappears. If both tendons are affected at the same time, 
recovery is doubtful. Of course, the seriousness of the prognosis varies 
with the severity of the lesions and the thickness of the altered fibrous 
structure. Again, it has been observed that sprains of the tendon occur- 
ring suddenly are often incurable, while the lameness due to a slow, gradual 
and progressive inflammation of the tendons ordinarily disappears by proper 
treatment. The prognosis is evidently aggravated when there are bony, 
synovial or articular lesions already present, as well as by the complications 
they may bring on (synovitis, periostosis, knuckling). 

The new theories given upon the pathogeny of " nerf-f(^rure " leave the 
prophylaxis doubtful and poor. For light legs, douches, massage and care- 
ful shoeing are recommended ; thick heeled shoes are only indicated for 
low heels. Long bracelets in glove-skin or flannel bandages are also ad- 
visable. We must bear in mind that high heeled shoes and high heels 
predispose to lesions of the suspensory, and that dry roads and speed are 
the worst enemies of tendons. 

The therapeutics of the disease includes numerous more or less active 
indications ; but their results are uncertain ; quite often, the disease resists, 
progresses and brings on complications. A first important indication, 
common to all cases, is to place the tendon in conditions which will insure 
it the most complete rest. To this end an appropriate shoe will be put 
on, and the animal turned loose in a box stall. To immobilize the cannon 
and the fetlock, plaster bandages have been recommended. If the in- 
flammatory symptoms are severe, it is generally preferable to treat them 
by cold water, white lotions, compresses and alum water frequently changed. 
Ableitner advises to begin the treatment by the application of compresses 
as cold as possible or by irrigation; if compresses are used, they are 
changed for the night, by an application of wet clay alone or mixed up 
with salt and vinegar. Some prefer cold baths, the patient being placed in 
running water, three or four times a day, an hour at a time. Running 



SPRAINS OF TENDONS.— NERF-FERURE. — TENOSITIS. 3II 

water at 7-8 deg. C. is excellent. This treatment is stopped when the local 
hyperthermia has subsided, occurring ordinarily after two or three weeks. 
The cooling method is useful, especially at the onset, where there is great 
pain and marked tumefaction : it reduces the phlogosis of the tendon, 
arrests the interstitial hemorrhages and possesses a real sedative action. 
We combine with it light pressure by the use of flannel bandages or very 
thin rubber roller. 

At a more advanced period, the resorption of the exudate and of the 
extravasated blood must be stimulated. To this end, some practitioners 
have recourse to mercurial ointment or that of iodide of potassium ; 
others, more numerous, use blisters, red ointment, mercurial blisters, strong 
liniments. Sometimes several frictions are made in succession and suffi- 
ciently apart so as not to irritate the skin too much. In numerous cases, 
after three weeks to a month, the lameness disappears. Nevertheless the 
tissues preserve an exaggerated sensibility : any efforts may have for result 
to start a new inflammation ; hence a rest of several weeks is necessary 
after recovery. It is only by degrees and little by little that the anima 
can be allowed to resume work. 

Most of foreign authors prefer damp heat 2S\.^ pressure to blisters. Moller 
recommends to wrap the leg in moist and warm wadding held in place by 
a flannel bandage. The dressing is to be renewed every four or five hours. 
This method has a remarkable action against the suffusion and paratendi- 
nous infiltrations ; it prevents the secondary indurations. Ableitner, hav- 
ing obtained only unsatisfactory results with vesicating preparations, has 
given them up. After cooling applications used for a certain length of 
time, varying according to cases, he, like Moller, uses damp and warm 
compresses. The beneficial effects of this treatment, used when the in- 
flammatory phenomena have subsided, are incontestable. Yet, blisters 
count also many numerous successes ; they offer the advantage of being 
easier to apply and demand less time. The secret of success depends, 
however, on the long-continued rest given ; it is principally when the 
animal resumes his work too early that the trouble returns, that the inflam- 
mation of the tendon becomes chronic and that the leg knuckles. 

If cooling applications, damp heat or blisters fail, we must have recourse 
to fnassage, with or without hot affusions, or to cauterization. Recovery 
can be completed by massage, in covering the region with a sheet of 
parchment. The fingers, coated with vaseline, make light frictions on 
that sheet from downwards upwards in the direction of the lymphatic cur- 
rent ; in operating methodically the massage is done without changing the 
direction of the hair. These applications will be made twice a day, 
fifteen minutes at a time, and the treatment continued for several weeks. 
In serious cases and when massage has given only incomplete results, cau- 



312 VETERINARY SURGICAL THERAPEUTICS. 

terization may be used. Firing in transverse lines, penetrating points or 
in needles is preferred. Seldom is the superficial points cauterization, of 
old technic, now used. 

Some practitioners begin the treatment of light lesions by moist and 
hot compresses. In serious cases, others use astringents first, and cold 
for a week ; or, again, unmindful of the pain, make a vesicating friction 
(spirit of turpentine loo, cantharidis powder loo, euphorbium powder 
TOO, vaseline 400), and if necessary repeat it : when the scabs are off. 
they cover the region with a coat of ointment of iodide of potassium and 
immobilize it with a plastered bandage, which is changed after ten 01 
twelve days. If some induration of the tendon remains, they complete th« 
resolution with hot compresses and massage. 

Hunting, in the Veterinary Record, has on several occasions recom- 
mended the following treatment, which has given him good results : In 
day time, application of a pad of cotton-laine kept in place with a linen 
bandage ; during the night, pressure with a flannel roller ; besides massage 
and walking exercise. When the disease is chronic, a plastered 
bandage. 

For old tendinous sprains, or those formed slowly, whose lesions become 
marked gradually, as well as in all cases where the local sensibility and 
hyperthermia are limited, cauterization had better be used at once. 

When the disease is relatively recent, not subordinated to bony lesions 
and free from comphcations, good treatment gives a good proportion of 
successes. By his method, cold, moist heat and cauterization, Ableitner 
has obtained the following results : Out of 287 cases, 263 recoveries 
(among which a few incomplete), 24 failures. For 125 horses, recovery 
was obtained in one month; for 97, in about two; for 41 it required a 
little more than three. 

A certain number of cases of tendinitis resist the most rational treat- 
ment. Either the horse remains somewhat lame or again is entirely un- 
able to work. Then tttedian neurotomy is indicated. Peters, Moller, 
Goldmann, Blanchard, have shown the advantages to be derived from it 
in old lesions of tendons, which have resisted local treatment. To per- 
form it, the animal is cast on the lame side, the lame leg is drawn forward 
with a rope or carried in that position with the side-bar hobbles, and the 
other upper fore leg secured above the hock of the corresponding hind 
leg, when the region to be operated is well exposed. 

Then, exploring the internal face of the elbow with the fingers, by care- 
ful motions from forward backward and vice versa, the thick cord formed 
by the median nerve is readily detected (fig. 73). Oblique downwards 
and backwards, it is a little more superficial than the radial artery, with 



SPRAINS OP TENDONS.— NERF-FERURE.—TENOSITIS. 313 

which it passes, below the elbow, under the radius and the mass of the 
flexors muscles. 

The skin shaved and disinfected ; according to the quantity of cellular 
tissue and the thickness of the muscular layers, an incision 4 to 6 centi- 
meters long is made, on the course of the nerve, on a level with the inferior 
part of the articulation or immediately behind the superior extremity of 
the radius. A second stroke of the bistoury divides in the same direction 
and with the same length the sterno-aponeuroticus. If some hemorrhage 
occurs, it is stopped with affusions of boiled water or by plugging, torsion 
or ligatures being seldom required. The edges of the musculo- cutaneous 
wound kept open with spreaders, the antibrachial aponeurosis is exposed 
with a peculiar nacreous yellow coloration. Feehng the bottom of the 
wound with the finger, be sure that the nerve is situated well on the line 
of the incision ; in the contrary case, bring it there in carrying the leg 
slightly forward and backward. Then the aponeurosis is divided, or, 




Fig- 73-— Median neurotomy.— N, Median nerve ; A, radial artery ; V, one of 
the posterior radial veins. 

better still, a small incision is made through it on the lower -angle of the 
wound, and a groove director introduced into it from downwards upwards ; 
the bistoury, guided by the director, incises the aponeurosis from inwards 
outwards. This incision can be made also with a blunt bistoury. By 
cutting with the scissors a semi-elliptic piece of each edge of the aponeu- 
rosis (Moller) the median is more widely exposed. 

The nerve is isolated by dissection of the connective tissue or by tearing 
it with the end of the director ; the vessels and radial artery are carefully 
avoided. Should they be wounded, secure them with an hemostatic for- 
ceps, 



314 



VETERINARY SURGICAL THERAPEUTICS. 



The nerve being free, it is raised with forceps, an aneurism needle or a 
piece of thread passed first underneath it, and a piece of it (about 2 cen- 
timeters) is amputated, — the division of the nerve being made first at the 
upper end of the incision. The wound is then washed with boiled water ; 
the clots of blood that it may contain are cleaned away ; the edges of the 
wound are dusted with iodoform or covered with iodoformed vaseline, 
brought together with three stitches, including skin and muscle, and coated 
with collodion. Cicatrization may occur by first intention. If suppura- 
tion takes place, the stitches are cut off, the wound cleaned and treated 
antiseptically. It will be closed in about two weeks. 




Fig. 74. — Neurotomy of the sciatic— A, aponeurosis of the leg ; C, subcuta- 
neous cellulo-adipous layer ; N, sciatic nerve. 

This operation permits some animals to be used, for a variable length of 
time, which had remained very lame notwithstanding repeated cauteriza- 
tion ; still the operation cannot be considered as able to render the " im- 
mense " services claimed by some enthusiasts. 

Sprain of the flexor tendons is rare on the hind legs. Their treatment 
is the same as for those of the anterior extremity. Cool applications, 
moist heat, blistering or firing should be used. Should the lameness per- 
sist, and work is impossible, neurotomy of the sciatic can be used. (Rous- 
seau, Benjamin, MoUer, Vogel). 



SPRAINS OF TENDONS. — NERF-FERURE. — TENOSITIS. 



315 



The operation is made on the inner side of the leg, a hand's-breadth 
above the point of the hock. The horse laid on the lame leg, the super- 
ficial leg is secured on the corresponding fore leg, and the region to be 
operated is thus exposed. On the selected place the great sciatic is 
situated almost immediately under the tibial aponeurosis (fig. 74). The 
skin shaved and disinfected, make, 3 centimeters in front of the tendo 
Achillis, an incision 4 or 5 centimeters long, parallel to it. If there is 
hemorrhage, stop it as usual. Divide the tibial aponeurosis in the same 
direction and with the same length. Moller recommends to excise a 




Fig- 75- — Colt affected with knuckling on both fore legs (Moller). 

semi-elliptic piece of the aponeurosis on each lip of the wound. To ex- 
pose the sciatic nerve, it is good to use the groove director ; once isolated, 
a piece of the nerve (2 centimeters) is inserted with the same care as 
for the neurotomy of the median. The hemorrhage stopped, the wound 
is washed and closed by two stitches of suture. 

The cares required are those of all superficial wounds of operation : 
antiseptic lotions twice a day, vaseline or antiseptic powder ; cicatrization 
jS complete in two weeks, Benjamin has observed after this operation 



3l6 VETERINARY SURGICAL THERAPEUTICS. 

he elongation of the tendons, the fetlock touching the ground ; we have 
seen the same accident, and one sloughing of the hoof. Sciatic neuro- 
tomy seems more dangerous than median. This difference can be ex- 
plained : the section of the sciatic above the hock removes all sensibility 
in the lower part of the leg, while that of the median leaves a certain 
amount of it, due to the cubital nerve, which co-operates to the formation 
of the external plantar. 

VII. 

KNUCKLING. 

Knuckling is congenital or acquired, essential or symptomatic. It is 
specially common on the fore extremities. In adults, the deviation of 
the fetlock is either essential, connected with tendinous lesions, or again 
symptomatic, secondary to one of the numerous painful diseases of the 
anterior extremity ; more particularly those of the feet or of the digital 
region. Young horses are subject to an essential form of knuckling, or- 
dinarily differently marked on both legs (fig. 75). 

The remarkable extensibility of tendons in colts permits the easy cure 
of this knuckling of youth. Numerous examples of it are recorded (Ehrle, 
Friebel, Brunet, Ostertag, Easy, MoUer). When the deviation of the 
phalanges is not great, the cutting away of the heels, an elongated toe 
shoe raised at its point, will be sufficient, if the animal is turned loose in 
a field. If the ailment is more marked, it may be reduced with the hinged 
splints, by which the fetlock is pushed backwards. The orthosome of 
Brogniez is useful here (fig. 76). 

In the Recucil oi 1881, Brunet has described an apparatus which has 
given him good results. It is applied as follows : A shoe, the branches of 
which are elongated backwards and united by a crosspiece, is put on the 
shoe. From the crosspiece rises a metallic upright which carries a plate 
of sufficient height to reach the back of the knee in a fore leg or the 
chestnut of a hind leg, and about 2 centimeters in thickness. This plate, 
hollowed and padded, carries two leather straps, one near the superior ex- 
tremity of the canon, the other a little above the fetlock ; they allow 
regulated traction on the deviated levers and permit of them being grad- 
ually brought back in their normal position. The filly treated by Brunet 
was much knuckled on the left fore leg and rested on the toe ; she was 
straight in twenty-two days (no relapse). Another was affected on the right 
hind leg to such extent that the entire anterior face of the wall of the foot 
rested on the ground, from the toe to the coronet. In five weeks the 
animal had recovered, and her fetlock was straight. 



ICNUCKLINCJ. 



317 



The application of splints and plaster dressings have also been recom- 
mended after a forced extension of the phalanges on the canon, made 
while the animal was secured in cubital position. Recovery has been 
obtained in several weeks. The dressing has to be changed at various 
times, as the leg resumes its proper function. Tenotomy of one or both 
legs is performed, if the other treatments fail. Generally the section of 
the perforans is sufficient. 

Knuckling of adults is a common complication of tendinitis and of the 




Fig. 76. — Orthosome of Brogniez (Peuch and Toussaint). 

various affections met with in the inferior regions of the extremities. 
According to the cases, the tendons are simply retracted, or, on the con- 
trary, inflamed and swollen. The fetlock is carried forward so much 
more if the lesion is serious and old. The first indication of a rational 
treatment consists in treating the cause: tendinitis, navicular diseases, 
seams, exostosis. When the retraction is slight -in cases of knuckling of 



3i8 



VETERINARY SURGICAL THERAPEUTICS. 



the first degree — and the actions of the animal are again free, the trouble 
may disappear by exercise. If already the deviation is more accused, the 
overtaxed bony levers become inflamed ; the tendons, carrying no longer 
their share of the weight of the body, retract more and more, and thus, 
generally speaking, tenotomy must be resorted to. By turn highly recom- 
mended and again objected to severely, this operation often gives imme- 
diate and remarkable results, but quite as often the results are far from 
satisfactory. Exposed tenotomy is no longer performed. The subcutane- 
ous method is used in our day. The animal is first shod properly. If 
the perforans alone is to be divided, the foot, with the heels pared away, 
should have a shoe with an elongated toe, so as to throw the weight of the 
body upon the posterior parts of the foot. In double tenotomy, to avoid 
the dropping of the fetlock backwards, the orthosomes of Brogniez and of 
Defays, or, better, the immovable bandages (Didot, Delwart), are recom- 
mended. (See Tendinous Woinids^ 

Whether a fore or hind leg is to be operated, the animal is cast on the 
opposite side, the leg left in the hobble. A rope is placed round the foot, 

another above the knee or 
the hock. The skin is wash- 
ed, shaved, asepsized on the 
middle third of the external 
face of the canon. Two in- 
struments, straight and curv- 
ed tenotomes, are necessary. 
Instead of the straight teno- 
tome, a narrow scalpel or 
bistoury can be used (fig. 77.) 
Placed in front of the knee 
or near the hock, by careful 
exploration of the tendons 
the separation which exists 
between them is readily made 
out ; when the tendons are 
surrounded by indurated tis- 
sue, this separation is not so 
readily made out. On the 
hind leg the middle of the 
canon is the spot of elec- 
Fig. 77.— Knuckling and phalangeal perios- tion, on the fore leg a trifle 
tosis. (From a photograph.) above it(i or 2 centimeters.) 

In the first step of the operation, the right hand, holding the straight 
tenotome, is thrust between the tendons undl the point is felt under the 




RNUCKLlNG. 519 

skin of the opposite side ; while there slowly pull it away from the tract it 
has made ; the curved tenotome is then introduced in its place and its 
sharp edge brought in contact with the perforans. Taking a point of 
support with the thumb on the anterior face of the canon, the section of 
the tendon is made by a very limited sea-saw motion of the hand, while at 
the moment of the division the assistants are pulling on the ropes at the 
foot and at the knee in different directions, that of the foot forward, the 
other backward. With care, the skin is seldom cut more than the point 
of introduction of the tenotome. If double tenotomy is performed, 
divide the perforans first, then pass the tenotome behind the perforatus 
and divide it as the perforans was. The division from forward backwards 
exposes a large incision of the skin ; clean up the region, close the cuta- 
neous wound with collodion and apply a slightly compressive bandage. A 
bloody extravasation fills up the space left between the extremities of the 
tendon, the surrounding connective tissue becomes inflamed and a piece 
of embryonic tissue is soon formed. The swelling, first warm and painful, 
gradually diminishes and indurates. After two months, the newly formed 
tissue has obtained sufficient resistance to allow resuming work. After- 
wards, like all cicatricial tissue, a more or less marked retraction takes 
place and for a long time it is the seat of an abnormal sensibility which 
interferes with the motions of the animal or lames the horse. 

The accidental section of one of the nerves of the canon is of no im- 
portance ; wound of the artery, very rare, demands the application of a 
compressive bandage. More serious is the opening of the carpal, tarsal 
or sesamoid sacs — which can occur only with those lacking anatomical 
knowledge. Simple cleanliness prevents the suppuration at the traumatic 
center. 

As remarked by Bouley, the work of cicatrization of one or the other of 
the tendons is always followed by their intimate and lasting union. The 
perforans and perforatus are solidarized, the mechanism of the ring of the 
perforatus is destroyed ; now the phalanges, almost immobile upon each 
other, do not flex any more, and the horse is always liable to stumble 
and fall. He can no longer be utilized to fast gait, so much go that the 
neoformed structure remains always more vascular, more sensitive and 
more exposed to dilacerations than the normal fibrous tissue. However, 
tenotomy allows some horses to be used which otherwise would have 
remained unfit for work. 

It is not the case, however, that successful results obtained by tenotomy 
remain always lasting, even where the cause of the knuckling has been 
properly treated. Against relapse, blistering and firing applied on the 
retracted cicatricial tissue have been recommended. A second tenotomy 
is the only thing to replace the leg in its proper position j but, from an 
economical point of view, it is not advisablei 



320 VETERINARY SURGICAL THERAPEUTICS. 



VIII. 
SPRUNG KNEES. 

The deviation of the knee forward of the plumb-line, produced by the 
obliquity of the bones of the fore arm and of the canon, is most com- 
monly the result of excessive work, an indication of wearing of an extre- 
mity : the horse suffering with it is called " sprung-kneed." Sometimes, 
however, the conformation is observed in young animals as a congetiifal 
malformation, or again occurring in the first days of life. These are called 
" brassiconrts " by the French. 

The treatment is indicated in animals with which this conformation is 
congenital or occurring during the first years of life. When it is due to 
overwork, to wearing, the subject is not worth intervention. 

Sometimes the deformity is much marked. Brachet has related the 
case of a filly which, perfect at birth, was, towards the third month of her 
life, so severely affected on both fore legs, that both heels nearly touched 
the elbows ; the animal was walking on her knees, almost as fast as other 
sound subjects of the same age. Strong pulling on the lower end of the 
leg was not sufficient to open the radio-metacarpal angle, so powerful was 
the retraction of the flexors of the canon. Other authors have men- 
tioned similar cases. Suykerbuyck has seen an eight day colt whose 
right anterior leg was sprung and knuckled to such a point that the leg was 
resting on the metacarpo-phalangeal joint. When the deviation is not 
much marked, it may be removed by proper splints. Brogniez has in- 
vented an orthosome which can be used in such cases or applied after 
carpal tenotomy. SoUeysel and Lafosse, thinking that sprung knees were 
due to shortening of the coraco-radial aponeurosis, proposed its subcuta- 
neous division. The operation has given some success (Brogniez, Chas- 
saing), but the result is doubtful. 

Retraction of the external and oblique flexors of the mecatarpus seems 
to be the great cause of sprung knees. Numerous authors, and among 
them Dieterichs, Hering, Brogniez, Bassi, Brachet, Chassaing, have pub- 
lished the successes they have obtained by the section of those tendons. 

Miquel, on an animal sprung on both knees, cut the tendons on one 
leg first, and several days later on the other : the animal recovered its 
plumb-standing. A ten-year-old horse, not so severely affected, was 
operated on both legs at one sitting. The wounds were closed with pinned 



SPRUNG KNEES. 



321 



sutures ; cicatrization took place without suppuration ; twelve days after 
the callus formed by the union of the tendinous stumps was as hard and as 
big as a French nut. From that time he had walking exercise, a month 
later did light work, and afterwards resumed his ordinary life, all cured. 

In a filly, Brachet first made on the level of the tendons an incision (3 
centimeters long) parallel to the fore arm, and 
divided them with a concaved bistoury. The 
result not being sufficiently satisfactory, he 
made " another section of the epicondilo me- 
tacarpal (internal flexor of the metacarpus), 
which prevented the complete extensions of 
the leg." The knee straightened almost en- 
tirely and there remained very little deviation. 
The separation of the ends of the tendons was 
about seven centimeters. The knee was placed 
in a padded splint held in place with a wide 
bandage. After a month the animal was free 
from pain and in one year had as good, firm 
action as others of her age (fig. 78). 

Like plantar tenotomy, the suscarpal must 
be performed subcutaneously. ■ 'Lafosse, Gour- 
don, Peuch, have described ''the operation, 
which includes two steps : t^f, Section of the 
external flexor j 2nd, that ofeth"^ oblique. 

The animal is thrown oil' We' sound side; 
one rope is secured on the ii|DJ)er portion of Fig- 78.— Part of the fore 
the fore arm, and puUed^'backwaftis ; another, ^"^"^ and knee (posterior 
attached to the canon or to thef6ot, is pulled f^c^)--^^' ^^^1^^"^ flexor 
forward. "' 

The operator places himself in front of the 
knee. The region prepared, a narrow puncture is made through the skin 
and the subcutaneous aponeurosis, about 5 centimeters above the suscar- 
pal bone, on the anterior border of the external flexor. Then the curved 
tenotome is introduced under the tendon, as far as its posterior border, 
and with it the tendon is divided, from forward backward, while the assist- 
ants are pulling on their ropes. The section of the oblique flexor is done 
in the same maniier, the puncture of the skin being made on its anterior 
border and the division done as before. 

By cutting the tendons from backwards forwards, as in plantar tenotomy, 

there is more danger to cut the arterial divisions situated between the per- 

foratus and the perforans ; if the operation is performed too near the knee, 

there is danger of injuring the articular svnovial sac or the carpal bursa. 

21 




nietacarpis ; Fe, external 
flexor nietacarpis. 



322 VETERINARY SURGICAL THERAPEUTICS. 

There is sometimes an abundant hemorrhage, but a simple ligature or a 
compressive bandage are sufficient to stop it. 

According to Chassaing, the section of the tendon of the external flexor 
is all that is required in the majority of cases. But if the bend of the 
knee is great, double tenotomy is preferable. 

Sometimes the straightening of the knee takes place immediately, at 
others it requires some time. In the cases where the knee has a tendency 
to bend backwards, the padded apparatus of Brachet or the orthosome of 
Brogniez can be used with advantage. In this way the articulation is kept 
in normal condition until the cicatrization is completed, and when the 
apparatus is removed, after about twenty days, the knee keeps the position 
which it has received. 

When the deviation seems due to a simultaneous retraction of the 
flexors of the metacarpus and of those of the phalanges, it is, as suggested 
by Lafosse, proper to complete the suscarpal tenotomy by that of the 
perforans. In a twelve-days old colt, Chassaing made the section of ex- 
ternal flexor, and a month later double plantar tenotomy. Recovery was 
not complete until four months after the operation. 

In young dogs, it is quite frequent to observe a deformity of the anterior 
legs, somewhat similar to the sprung knees of horses, an exaggeration of the 
flexion of the metacarpals upon the fore-arm, due to the retraction of the 
flexor tendons. This deformity may exist in one or both legs. Generally 
suscarpal tenotomy succeeds. With the straight tenotome, introduced un- 
der the external and oblique flexors of the metacarpus, these are divided. 
Sometimes the division of the perforatus is necessary (Peuch). A dressing 
with splints or pasteboard, extending from the lower end of the paw to 
the superior extremity of the fore-arm, will keep the bones in their proper 
position. After five or six days, the dressing can be taken ofl ; the wound 
is cicatrized. The straightening of the leg takes place gradually. 

IX. 

TENDINOUS HELMINTHIASIS. 

The reticulus spiroptere is found not only in connective tissue and 
arterial walls, but also in tendinous and ligamentous tissues. The cervical 
ligament, suspensory ligament, tendons of the perforans and perforatus 
seem to be the most affected! When these exist on the legs, they give 
rise to true tendinitis with lameness (Barrier, Mauri). Ordinarily the 
deformity and sensibility of the affected organ permit the diagnosis ; but 
there are cases where those are missing. The horse mentioned by Mauri 
was very lame on the left fore leg ; the knee was constantly flexed ; by 



TENDINO^^S HELMINTHIASIS. 323 

pressure of the suspensory ligament, an acute sensibility was manifested, 
but no deformity was visible " neither on the tendons nor on the carpal 
bursae." Fine points firing applied twice did not remove the lameness. 
The horse was destroyed. In such cases it would be well to try deep 
penetrating points firing or median neurotomy. 



CHAPTER V. 

TENDINOUS SYNOVIAL SACS. 

I. 

TRAUMATIC LESIONS. 

Contusions of tendinous synovials are not rare. Slight, they terminate 
rapidly by resolution. When they are due to violent traumatic actions, 
specially when the injured bursa is on the level with a distended cul de 
sac, a bloody extravasation may take place in the sac ; or sometimes a 
closed synovitis may follow. Their treatment is that indicated in the 
chapter on contusions in general. Later, if indicated, that of acute 
synovitis will be prescribed. 

There is great analogy between wounds of tendinous and those of 
articular synovials : same causes, same symptoms, same terminations. 
At times, one may hesitate in the diagnosis. There is a deep wound on 
the surface of the knee, of the hock, of the fetlock ; there is escape of 
synovia; which sac is open? When there is no coexistence of tendinous 
and articular lesions, the topography of the synovials and the seat of the 
wound will solve the question. In doubtful cases, probing may give some 
light, but it is a dangerous operation. The therapeutical indications being 
the same in all cases, it is useless to expose a serous membrane, which 
may be aseptic, to infection. 

The treatment of penetrating wounds of tendinous synovials has varied 
much with time. Antiphlogistic method (bleeding, poultices, emollient 
lotions of all kinds) was abandoned long ago. Cold water and astringents 
have been often used successfully. Arnal has treated with cold baths 
and astringent lotions a steer wounded above the fetlock, by the prick of 
a fork, which had entered the' sesamoid sheath ; the animal resumed 
work in a week, the cicatrization taking place by first intention. On a 
horse suffering with a punctured wound of the foot, in which the small 
sesamoid synovial was injured, the result was as satisfactory : the foot 
unshod, the sole thinned out, the wound was covered with pads kept in 
place with a piece of leather, and the shoe secured with four nails ; 
the horse was placed in running water in day time, and during the night 
had Goulard extract lotions applied ; in six days, recovery was completed. 
Trasbot has related a similar case : a nail had also penetrated the small 
sesamoid sac, the sole was thinned out, the fistula enlarged, and the 
wound irrigated with cold water; the 12th day, it was cicatrized. 
324 



TRAUMATIC LESIONS. 325 

Some authors, balieving that the flowing of the synovia was the only 
obstacle to the cicatrization of the trauma, have had recourse to coagulat- 
ing agents. Causs^ and Peuch have recorded cases showing the ad- 
vantages derived with tannin. Causs^ says he has cured with it four 
cases of wounds of the sesamoid groove injured by nails and one of the 
synovial of the tendon of the gastrocnemius. The horse treated by Peuch 
was suffering with a penetrating wound of the tarsal sheath ; l)listering 
frictions on the hock and cauterization of the wound with sublimate 
having failed, with tannin recovery was quite rapid. Other practition- 
ers have used successfully aegyptiacum ointment in dressings, as in cases 
of wounds of articular synovials. 

On account of the obturating eschare that it produces, actual cauterization 
or potential caustics has, for a long time, been considered by some as the 
best treatment. Sublimate and nitrate of silver have specially been used. 
In the observation of Knoll, the great sesamoid sac and the articulation of 
the fetlock were open ; sublimate, used after several other treatments had 
failed, brought on recovery. With sublimate collodion (15 parts in 30) 
Francois has obtained the rapid closing of a wound of the tarsal sac. 
In a horse affected with a wound of the small sesamoid sac due to a 
fracture of the bone, Verlinde enlarged and cleaned the wound, cauterized 
the fetlock with sublimate powder, and applied an antiseptic dressing. 
No complication occurred. 

Nitrate of silver has been praised by Barthe, Dangel, Ribaud. With 
repeated cauterizations by this agent, synovial wounds close rapidly. The 
mare of Barthe, which had an open sesamoid sac after a too severe firing, 
recovered rapidly. 

Many practitioners have combined vesicating, coagulating and cauter- 
izing agents. The caustic tar (a tablespoonful of Norway tar, half a tea- 
spoonful of sulphuric acid at 66°) has given Cagnat good results in the 
treatment of wounds of the anterior face of the knee, involving the ex- 
tensor tendons and their sheaths. 

Though penetrating wounds of tendinous synovials may get well by the 
use of so varied forms of treatment, to-day all those last, except con- 
tinued irrigations, are with justice replaced by antisepsy. Pricks, after 
careful disinfection of the skin, are covered with iodoformed collodion 
and a wadding dressing. More extensive wounds should be first well 
washed, carefully irrigated with a strong antiseptic solution, especially if 
some hours have elapsed since they were received ; their edges should 
be shaved ; stitches placed at their extremities will prevent their gaping 
to excess ; and if asepsy is sure and complete they may be entirely closed 
by stitches with or without drainage. A wadding iodoformed dressing 
insures immobilization. 



326 VETERINARY SURGICAL THERAPEUTICS. 

II. 

TRAUMATIC SYNOVITIS. 

Whether traumatic synovitis succeeds infected synovial wounds or is 
consecutive to a closed synovitis ending by suppuration, its symptoms are 
in all cases very expressive: there is a fistula through which escapes a 
yellowish, clotted, more or less purulent liquid; the region is warm, pain- 
ful, oedematous ; lameness is great if it is the synovial of a leg; there is.- 
more or less traumatic fever. One may hesitate between synovitis and 
arthritis. In this last, however, the functional disturbances are more 
marked ; the lameness greater ; the swelling, more extensive and diffuse, 
spreading evenly on the whole periphery of the joint, while in synovitis it is 
limited to the side of the leg where the synovial exists, or much more 
marked there than on the opposite side. 

According to Lafosse, synovitis would not be any more dangerous than 
simple peri-articular phlegmons. With the great majority of authors, 
we believe that suppurative inflammation of a tendinous synovial is always 
a serious accident. Evidently the prognosis varies with the importance 
of the synovial injured, the character of the wound, the length of time 
it has existed. In some cases, the inflammation extends to the tendon,, 
and with a suppurative teno-synovitis, the practitioner must be modest in 
his opinions. Recovery is sometimes singularly favored through parti- 
tions in the synovial by septum or bands ; the infection, instead of spread- 
ing in the entire serous, remains localized on one point, sometimes one of 
the cul de sacs. As a consequence of synovial inflammation, generally 
strong adhesions take place between the walls of the sac, the sliding of 
the tendon becomes difficult, the animal remains lame. 

All the treatments indicated for synovial wounds have been recom- 
mended against traumatic synovitis. The two therapeutic metliods that- 
are favored by practitioners are hydrotherapy and antisepsy. If the 
former is used, sometimes the wound and surrounding region are simply 
irrigated with a rubber tube fixed above it; or again, by enlarging the 
fistula and placing a drainage tube. Through the action of cool water,, 
purulent secretion diminishes and recovery may be obtained. We prefer, 
instead of cold water, antiseptic injections, following the necessary enlarge- 
ment of the fistula. Sometimes a counter-opening and then a drainage. 
Like Mauri and Labat, we generally use sublimate i in looo in injections 
every two hours ; by degrees the discharge diminishes, the rational symptoms, 
improve, the wound closes rapidly. Landreau has reported a case of syno- 
vitis of the sheath of the anterior extensor of the phalanges, cured in four 



CLOSED ACUTE SYNOVITIS. 327 

'days. Sometimes the suppuration is slow to stop, and recovery demands 
six weeks or two months to take place. Too often adhesions have taken 
place ; the tendons do not move any longer in their sheath ; there re- 
mains a marked stiffness, so much more that the suppuration has lasted 
longer. Massage, warm water, moderate exercise, form the base of the 
treatment during convalescence. When an important tendinous synovial 
(carpal, tarsal, great sesamoid) has been the seat of suppurative inflam- 
mation, it is rare if the region recovers the entire freedom of its motion. 
In such cases, to overcome the remaining induration, cauterization must 
■be resorted to. 

III. 

CLOSED ACUTE SYNOVITIS. 

Due to various causes (overwork, contusions, luxations, sprains, juxta- 
epiphysar fractures, perisynovial abscesses), simple acute synovitis offers, 
in its mode of development, various characters which have justified the 
■division into a dry form (crepitant or plastic synovitis) and another with 
effusion (serous or purulent synovitis). On account of its superficial 
situation and the important part it plays during locomotion, the great ses- 
amoid synovial is the most frequently affected. 

In crepitant synovitis, there is no marked exudation ; the congested 
serous, partly deprived of its endothelium, remains dry and the friction of 
its wall gives rise to a sort of crepitation. This variety, which sometimes 
is but the initial condition of the serous synovitis, has not been well 
studied in our animals. 

Plastic synovitis begins also dry ; the synovial becomes covered by a 
layer first embryonic, then fibrous, which creates tendinous adhesions. It 
occurs specially after sprains, luxations or traumatic synovitis. The ten- 
don, more or less ankylosed in its sheath, retracts; and functional impo- 
tence or deformity of the joint are the results. When they exist in the 
tendons of the flexors of the phalanges, these " vagino-tendinous sym- 
physis " promote the production of knuckling. 

Serous sytiovitis is characterized by the exudation, on the surface of the 
synovial, of a reddish liquid, gathering in the cavity and distending its 
•cul de sac. 

The clinical characters of acute synovitis and anatomical data permit 
an easy diagnosis. The region is painful, tumefied, and little by little the 
serous is distended, pushed out by the fluid accumulated in it. 

At the beginning, the inflammatory phenomena are treated by rest and 
■continued irrigation or by cold compresses and repeated astringent lotions. 
To control the intra and perisynovial exudation, it is advantageous to apply 
on the compresses a band of flannel or of linen ; rubber bands can also be 



328 VETERINARY SURGICAL THERAPEUTICS. 

employed. The bandage of Delorme answers the same purpose. (Se& 
Sprai7is.) 

Sedative applications are indicated if pain is great. Sedative fomenta- 
tions will be advantageously employed. Generally the phlegmatic phen- 
omena subside ; but ordinarily there remains a dropsical condition of the 
serous with thickening of the perisynovial tissues. Hot, moist compresses, 
massage, elastic roller, slight exercise relieve small exudations and tendin- 
ous stiffness. When their action is insufficient, blistering and firing are re- 
sorted to. Acupuncture is preferable to the last even completed by iodu- 
xated application and pressure. If there is excessive tension of the 
synovial walls, aseptic ptmcture with the trocar is indicated, with or with- 
out the washing of the serous sac. 

When suppuration occurs, one may, from the start, resort to phenic 
washing of the synovial, but if the symptoms become aggravated, it is 
better to freely open the sac, drain it and make antiseptic irrigations- 
Then the prognosis is very serious ; often, if the treatment is continued,, 
it lasts several months and recovery is incomplete. 

IV. 

INFECTIOUS SYNOVITIS. 

In the course of some general or infectious diseases, there sometimes 
appear closed, acute synovitis, serous or purulent. Rheumatism, glanders, 
distemper, typhoid fever, purulent infection, tuberculosis, pleuro-pneumonia, 
dourie, variola may occur with them. In horses, they are commoa 
during or after pneumonia. 

Infectious synovitis are due either to the pullulation, on the surface o£ 
the serous, of the specific micro-organisms, or to the irritating action of the 
toxins eliminated by the serous system. Their symptoms and march arer 
identical to those of the closed acute synovitis, but the presence of the 
producing diseases guides the diagnosis. The treatment includes anti- 
phlogistics at the start, later warm water, massage, blistering and firing. If 
the severity of the inflammatory symptoms makes one fear suppuration,, 
puncture with phenicated or sublimated washing is indicated. General 
treatment may be useful ; in presence of a rheumatismal synovitis, salicylate, 
of soda will be prescribed. 

Para or metapneinno7iic synovitis are peculiarly common in horses, where 
they have already been described as rheumatoid synovitis. Out of sixty- 
eight cases of " diseases of the chest," Palat has seen this complication 
live times. Bouley Jr. thought it was also common after pleurisy ; to-day- 
it is recognized that it occurs habitually with pneumonia. It is observed, 
also in man. Chomel, GrisoUe, Andral, Gintrac have seen it. 



INFECTIOUS SYNOVITIS. 329 

During convalescence or when the animal has recovered, lame- 
itess, at times very severe, appears from one day to the other ; several 
members may be affected at once. According to Bouley Jr., it shows itself 
most commonly from fifteen to twenty days after the appearance of the 
thoracic trouble, and according to Trasbot from the twentieth to the twenty- 
fifth day. Sometimes it occurs later. Palat has observed it three months 
after pneumonia. It may affect tendinous or articular synovial sacs ; but 
has a predilection for the great sesamoid — that of the fetlock. 

The exploration of the lame leg allows the recognition of the diseased 
synovial. There is oedematous swelling, heat and pain of the region ; 
these with the previous history render the nature of the trouble sus- 
picious. What characterizes it essentially, is its ambulatory character, its 
moving from one serous to another. Trasbot has seen it affecting suc- 
cessively the two great anterior sesamoid sheaths, then the two posteriors 
and afterwards the two carpals. 

Starting with the idea that the disease resulted from the accumulation 
in the blood of the products of disassimilation — urea, uric or hippuric 
acid, coloring matters, bilious salts — and of the irritating action that 
they would produce upon tendinous synovials, Trasbot believes that 
they can generally be prevented by the use of diuretics at the period of 
resolution of pneumonia. Evidently, the blood undergoes serious changes 
during the inflammation of large parenchymas, but it is hard to explain 
the long retention of these products and their slow action. And again it 
is impossible to reproduce experimentally the affection in injecting in the 
veins, even in larger quantity, these products of disassimilation. 

Bacteriology has inquired into the nature of metapneumonic synovitis. 
For man, it is known to-day that it is an inflammation produced by the 
infectious element which gives rise to pneumonia. This pseudo-rheuma- 
tism penumonia, promoted by the single pneumococcus, is not serious ; 
at times there is no pure pneumococcic infection ; the pyogenus strep- 
tococcus is sometimes associated with the pneumococcus. (Jaccoud and 
Netter, Meunier.) 

The preservative action of diuretics (bicarbonate of soda, nitrate of 
potass) is uncertain. Many practitioners have seen synovitis appear in 
pneumonic patients treated by diuretics, antiseptics, or by both. A good 
pieventive treatment is yet to be found. The curative treatment includes 
local means and an internal medication. We have little faith in setons 
tinder the chest, as recommended by Palat. The application upon the 
synovial of a blistering preparation, the daily administration internally of 
salicylate and bicarbonate of soda, is the therapeutics which has given us 
the best results, salicylate specially. We give it in doses of 20 to 30 
grammes a day; it may be carried to 100 and 150 grammes (Fried- 



330 VETERINARY SURGICAL THERAPEUTICS. 

berger and Frohner). By the combination of these means, a rapid im- 
provement is habitually obtained ; sometimes in less than 1 5 days 
the lameness disappears. If dropsy of the serous remains, firing generally 
removes it. That which renders the prognosis serious is the peculiar 
moving about character of the disease, which involves other serous. 
"When one first lameness is relieved, and the animal is ready to resume 
work, another synovial may be affected and the disease reappears in it 
with all its acute characters. However, cases similar to that of Trasbot, 
where the lameness lasted eleven months, are absolutely exceptional. 

If the severity of the inflammatory phenomena indicates the possibility 
of suppuration, aspiration followed by phenicated washing may prevent 
the ulceration of the synovial. 



CHRONIC SYNOVITIS— DROPSIES. 

Common in horses, they are due to the same causes as hydarthrosis 
are. They sometimes follow acute inflammation of serous, or again and 
most frequently under the influence of excessive work. Most of the 
animals used for a long time to heavy work have on their legswindgalls or 
thoroughpins. If the accumulation of synovia in tendinous sheaths does 
not at first disturb the regularity of the movements, there is a moment 
when continually increasing it gives rise to lameness. 

In the places where it is less protected, the synovial sac protrudes. 
The dilatations, whose seat is known for each serous, always insure 
the diagnosis. According to the length of time of the affection, 
they are soft, fluctuating, or again indurated, calcified. The ordinary 
clinical characters of these dropsies may be modified by the partitioning 
of the cavity ; the dropsy is unevenly marked in the various culs de sac, 
sometimes even scarcely in one of them. The aspect of their fluid 
varies very much : often clear and serous at first, it is generally thick and 
dark in old dropsies. Sometimes riziform granula are found in them. 

By regular training, a moderate work proportionate to the organic 
resistance, by douches, massage, compression, one may, in numerous 
instances, prevent the dropsies of tendinous synovials. When they are 
recent, it is again the same means that are to be used, adding to them 
rest in a box-stall or in the field. Purgatives and diuretics are useless. 
Later, when the tumors have already reached a certain size, when the 
perisynovial tissues are indurated, more active treatment must be resorted 
to : blistering, strong liniments, cantharided collodion, sublimated collo- 
dion and a mass of more or less complicated preparations can be used ; 
but their action is less powerful and less certain than firing under any of 



CHRONIC SYNOVITIS — DROPSIES. 33 1 

its various forms. If one is not familiar with the technic of the needles 
cauterization, he may use the method of Leblanc. The following mixed 
method has given excellent results : With fine points irons the skin 
is fired through by two or three applications, and then with a red needle, 
and with one stroke, the synovial sac is perforated in the half or the third 
of the number of points made. 

For centuries, it was considered a good treatment to relieve the drop- 
sies of tendinous synovials by allowing the escape of the excess of synovia. 
From time immemorial, Arabs have opened the thoroughpins of their horses 
with the red iron. Notwithstanding the success obtained by Bosco, this 
process is dangerous, when the puncture is not made with a very small 
point. Some authors have advised the use of the bistouri. With it 
specially, one must take great aseptic precautions, if he wishes to 
avoid the infection of the synovial; it is after all a " synoviotomy " that 
must be made. Capillary puncture, made asepiically, is without danger ; 
one must be careful not to make it in the few days following cauterization, 
when the points suppurate and the skin is infiltrated ; a careful dis- 
infection does not render the skin aseptic and the trocar may carry in- 
fectious elements in the synovial. After the puncture, the fluid often 
returns, but not with all the characters that it had first : the thick synovia 
is replaced by a clear fluid, more resorbable. Anyhow, the puncture can 
be repeated and completed by elastic pressure, blistering or firing. 

As soon as injections of iodine were recommended in human surgery, 
Leblanc and Thierry tried them in animals. If they have been put aside 
for hydarthrosis, they are yet used in the treatment of tendinous dropsies, 
where they have given numerous successes. Leblanc and Thierry, who 
studied comparatively injections of iodine, vinous injections, and firing in 
penetrating points, have published the results of their observations in 
1845. The solution of iodine (one part of the tincture in two of water) 
was injected in articular and tendinous synovials of the knee, hock, fetlock 
and in several mucous bursas. The results were excellent. " We are 
authorized, from those facts, in saying that the injections of iodine in 
mucous bursas and synovial sheaths of horses, can advantageously take 
the place of cauterization with the red iron, and that in the plurality of 
cases this medication must be used first." 

Those experiments were repeated by Bouley, Rey, Lafosse, Pressecq, 
Verrier, Barry, Festal, Abadie, Poret, Dupont and many others. The 
new method gave occasion for much discussion, and notwithstanding the 
influence of Leblanc, it is but little used by veterinarians, who have yet 
great respect for synovial sacs. The rules of the use of iodine are well 
described by Rey. For each synovial, the place of election is the most 
prominent part of the tumor ; it is there that it is easier to penetrate 



332 



VETERINARY SURGICAL THERAPEUTICS. 



into the cavity. A trocar, 2 or 3 millimeters in diameter, will be used, its 
three-faced point will penetrate through the tissues and leave an imper- 
ceptible opening which closes at once. Leblanc operated with the animal 

standing, but it is better ta 
cast him. The leg to be 
operated on is carried in 
extension. After all aseptic 
precautions have been taken 
(see Antisepsy), the operator 
takes hold of the trocar with 
the right hand, limiting his 
entrance through the tissues 
with his fingers, and he pushes 
it perpendicularly to the skin, 
or in a slight oblique direc- 
tion, by a gradual pressure 
with some rotatory motion. 
The rod removed, a jet of 
synovia escapes more or less 
abundant, according to the 
tense condition of the sac ; 
sometimes, however, it is nec- 
essary to squeeze the tumor 
to accelerate the flow. At 
the clinic of Alfort we use 
generally the aspirator of 
Dieulafoy or that of Potaia 
(figs. 79 and 80). Must the 
synovial be entirely emptied? 
Barry recommended to ex- 
tract only a small quantity ; 
he wished to reduce the effects of the iodine by mixing with the synovia ;. 
there is, however, cases where this is grumelous and escapes with difficulty ; 
and only a portion of it is removed ; but when it flows freely, as much as 
possible must be extracted. It is not necessary to inject a large quantity- 
of the iodine; according to the size of the sac, from 20 to 100 grammes 
are sufficient. An ordinary syringe can be used, though special instruments 
are better. The fluid is left in the pouch for a few minutes only ; gentle 
pressure insures the intimate contact of the irritating fluid with every 
point of the diseased membrane ; then a second evacuation is to be made. 
This is sometimes difficult, even with the aspirator ; clots filling up the 
canula of the trocar. Sometimes the greater quantity of the fluid has to- 




Fig. 79. — Dieulafoy's Aspirator. 



CHRONIC SYNOVITIS — DROPSIES. 



335 



be left in the cavity ; notwithstanding, the subsequent phenomena have 
nothing alarming. In a horse affected with a large tarsal thoroughpin^ 
we have injected lOo cubic centimeters of a solution of iodine to the third, 
without being able to draw out a noticeable quantity ; no accident resulted 
from it ; three months later, the tumor was considerably reduced. The 
operation ended, the canula is withdrawn, avoiding to pull on the skin, 
and the wound is closed with collodion. 

The solution of iodine has been used in various degrees of concentra- 
tion. In man, Bonnet has used it pure first, afterwards he employed a 
solution made of i6 grammes of water, 2 of iodine, 4 of iodide of potas- 
sium. Like Velpeau, Leblanc and Thierry mixed, as we said before, i 




Fig. 80. — Potain's Aspirator. 

part of the tincture with 2 of water. Barrier added to the tincture equal 
part of camphorated alcohol. We use the tincture of the Pharmacopoeia, 
to which we add 2, 3 or 4 parts of boiled water and a small quantity of 
iodide of potassium to dissolve the iodine which precipitates by the mix- 
ture of the two fluids. 

Though the animal shows no pain after the operation, absolute rest is 
indispensable. The days following, the region becomes painful and swol- 
len ; in some horses there is a high fever and great lan.eness; others 
exhibit but slight reaction. When the operation has been made asepti- 
cally, the inflammatory phenomena soon diminish. After the fourth 
week the animal can resume his work. The therapeutic results cannot be 
appreciated for several months. 

How do iodined injections act? For Perosino, they produce adhesions 
of the synovial walls. Bouley long ago showed this to be an error : " the 
serous in the parts where it is far from the center of the motion, in its 
diverticulums, is very vascular ; there, deposits of plastic matter take place 



334 VETERINARY SURGICAL THERAPEUTICS. 

■ which glue and unite the walls together by their free face, in such a way, 
that in the center itself, on the articular surface, on the parts of tendons 
which rub and slide over smooth grooves, no false membranes are formed ; 
the freedom of motion is preserved by that of the rubbing surfaces. 
Irritating frictions give rise by adhesion, far from the center, to the dim- 
inution in the size of the sheaths. Besides this, they modify the general 
vascularity of the membrane, and hence act upon its secretion." 

A high fever and severe local phenomena may demand pulverized 
douches or cold lotions on the region ; but if the operation has been well 
done, no serious accident is to be feared. 

The entrance of air in the synovial is without influence upon the subse- 
quent manifestations. Complications attributed to it are the results of 
other causes. Many injections are made without washing of the skin, or 
clipping the hair; is it surprising that suppuration should occur? It has 
also happened that a fraction of the iodined solution has been injected in 
the subcutaneous tissue. 

Leblanc and Thierry have made a series of thirty-five injections (15 ia 
joints, 7 in mucous bursse, 10 in tendinous sheaths and 2 in the pleura) 
without having had a single accident. Less skilful and less clean operators 
have had afterwards suppurative inflammation of the dropsical synovia 
— a complication which, in a number of cases, has ended fatally. 

Tincture of iodine is not the only fluid to use ; phenic acid at 3-5 p. 
100; thymic acid at 5 p. 1000; sublimate i p. 1000 and most of the 
almost concentrated antiseptic solutions have been used. Chlorhydrate 
of morphine and ergotine have given to Lafifltte excellent results. Biot 
has related successes obtained by the injection of blood. Stottmeister has 
recommended the injection of 5 to 10 centigrammes of eserine dissolved 
in 5 to 10 grammes of water. 

When the serous is much thickened or lined with a fibrinous deposit 
ordinarily all those means fail. It is in those severe cases that it is 
advised to open the synovial. 

The incision of a tendinous synovial may be done, in all species, with- 
out accidents — providing the rules of asepsy are minutely carried out. In 
the horse, if one has a convenient local, and is assisted by one or two 
assistants familiar with the work, most rigorous asepsy can be made. But, 
in ordinary practice, it is difficult to realize all the necessary requirements 
and on that account veterinarians will do well to leave the incision of 
synovials alone. It is, however, well known that the opening of the 
sheaths of the extensor tendons is far less dangerous than that of the 
flexors — as claimed rightly by Glinther and Moller. 

If we wish to make the incision, here is the manner to proceed : 
twenty-four to forty-eight hours before the operation, the region is dis- 



CHRONIC SYNOVITIS— DROPSIES. 335 

infected, the hair cut short, the skin is shaved over a wide surface, its 
greasy secretion wiped off with etljer, and then washed with Van 
Swieten solution, and a compress moist with the same solution kept over 
the region. The animal cast and the leg properly secured, the compress 
is removed and a new disinfection of the skin made ; with an incision 
parallel to the long axis of the synovial, open it where it is most super- 
ficial, remove the fluid, the riziform granulations it may contain, with the 
finger or the curette, take off the fibrinous clots deposited on the surface 
of the serous, wash off the cavity with an antiseptic solution (sublimate 
I p. 1000 or phenic acid 3 p. 100), make a partial synovectomy in excis- 
ing a piece of the walls, close it with silk stitches and apply a wadded 
dressing completed with a plastered bandage. Be careful that the horse 
does not bite or kick the dressing off. The progress of the trauma is in- 
dicated by the general condition. After three or four days, generally the 
wound is closed, but the cicatrix is not strong. It is better not to re- 
move the dressing for a week. 

With this operation, Ries has cured a chronic synovitis of the great 
sesamoid and one dropsy of the precarpal sheaths of the anterior extensor 
of the phalanges, which had both resisted other means. 

Let us also mention the drainage of the synovia, studied in horses by 
Trinchera. It consists in making a small incision on the upper part of 
the synovial or one of its cul de sacs, in evacuating the fluid, making a 
counter opening on the most dependent part of the tumor, introducing a 
drainage tube through and irrigating the synovial with a sublimate solution 
I p. 1000. Serious inflammatory symptoms follow, which last for three or 
four weeks and gradually diminish as suppuration disappears. The free 
surface of the synovial becomes covered with granulations, but in favor- 
able cases the walls will not unite but become covered with an endothelial 
layer and the freedom of the movements remains. This treatment, usedf 
until to-day only for dropsy of the synovial of the extensors of the front o 
the knee, hock and fetlock, might be applied to carpal and tarsal sheaths. 

Specml Chronic Synovitis and Dropsies. 

/. — Sheath of the Biceps (^Coraco-Radialis). 

Sometimes the sheath alone is affected, sometimes also the tendon. In 
fact, most ordinarily, it is not only a simple synovial dropsy, but a dry 
synovitis or teno-sy?wvitis. If the contusions of the shoulder and upper 
part of the arm are its ordinary causes, at times the affection is brought 
about by heavy trotting work, violent efforts in pulling upon uneven 
ground ; it is quite frequent in omnibus and tramway horses (Williams). 



336 



VETERINARY SURGICAL THERAPEUTICS. 



It has been observed sometimes as accident of an infectious morbid con- 
dition, specially of rheumatism. « 

It is seen under two forms — an acute and a chronic state. In this last 
form, it may last a long time, and be accompanied with secondary lesions 
of the tendons and bone. In a horse treated by Villate, there was syno- 
vitis, osteitis, destruction of the bicipital groove and recent lesions of the 
articulation. In Goubaux's case, there were well-marked alterations of 
the groove and of the synovial, but the joint was free. MoUer has 
found exostosis and partial necrosis of the humerus. Williams met with an 
almost complete ossification of the tendon of the biceps. 




^. 



\ 



"\ 







Fig. 8i.— Horse affected with bicipital sj-novitis (MoUer). 

Inflammation of the sheath of the humeral biceps is indicated by 
very significant manifestations ; at rest, the leg is held in semi-flexion, back 
of the plumb line ; in walking, it is carried forward with difificulty, the 
forearm cannot flex on the arm, the foot drags more or less on the floor, 
the step is very short. In the observation of Villate, there were almost 



CHRONIC SYNOVITIS — DROPSIES. 33/ 

310 movements on the upper part of the leg, " flexion of the forearm was 
possible only when it was raised, and then the pain was so great that the 
animal pulled back and reared up." When the affection is bilateral 
both legs are as if they were hobbled together, locomotion is extremely- 
painful, the steps are short, the foot drags on the ground. Locally, more 
or less marked symptoms are observed and later a deformity of the region 
is present. At times there is a diffuse swelling, either on one or 
both sides of the tendon of the coraco-radialis, at times there is atrophy. 

This is a serious affection. The prognosis of the acute form is based 
upon the severity of the symptoms ; sometimes recovery is obtained ia 
five or six weeks ; in other cases it demands several months. Therefore, 
with Moller, we advise not to attempt the treatment on subjects of little 
value. Horses affected with " chronic intertubercidar synovitis " remaia 
always lame. They are only fit lor plowing (Williams). 

Absolute rest and cool applications are the therapeutics of the beginning 
of the disease. Continued irrigation is the best. When acute symptoms 
have subsided, or when they are absent, as soon as the diagnosis is made, 
a strong blistering friction must be made on the point of the shoulder, 
and renewed, if necessary, after twelve or fifteen days. When improve- 
ment is slow, lines or needle cauterization is indicated. Later, whea 
blisters or firing have produced their effects, massage is applied twice a day 
on the shoulder and arm, and the animal exercised on a short walk 
morning and evening before he resumes his work. When the disease does 
not yield, the treatment is not to be kept up for too long a time except 
for valuable individuals. 

//. — Sheath of the Siib-spinatus. 

The tendon of this muscle and the bursae which assists its gliding- 
upon the trochiter are sometimes the seat of an inflammation produced 
by an excessive muscular contraction, a sprain or a bruise. The carry- 
ing of the leg in abduction, at rest as well as in action ; more or less lame- 
ness and the local phenomena of pain and swelling, are sufficient to make 
the diagnosis. 

For treatment, rest is often sufficient, and yet recovery may not occur- 
for six weeks or two months. Cooling or astringent applications are in- 
dicated at first, to be followed by blistering or firing when the inflamma- 
tion has sufficiently subsided. 

///. — Sheaths of the Knee. 

They are divided into (i) carpal thoroughpin ox of the flexors, ^wo. \x> 
distention of the carpal sheath, and (2) precarpal thoroughp^in or of the 



33S VETERINARY SURGICAL THERAPEUTICS. 

extensors, resulting from the dropsy of the synovials which assist the 
shding of the tendons of the extensors of the metacarpus and of the 
phalanges in front of the knee. 

The first is the most important. It is ordinarily characterized by three 
swellings ; two superior, oblong, situated between the radius and the flexor 
muscles, one on the inner, the other on the outside ; this last more dif- 
fused, more developed, and situated more posteriorly than that due to the 
dropsy of the radio-carpal articulation. The third swelling is cylindroid, 
and situated along the flexor tendons, in the upper half of the cannon. 
Dropsies of the sheaths of the extensors occupy the anterior face of the 
knee ; elongated according to the axis of the tendons, at times bilobulated, 
well distinct when they are of little dimensions, they may unite together 
when they enlarge. Their form, their situation, deeper than that of the 
hygroma, establish the differential diagnosis. Anterior articular dilatations 
of the knee are differentiated from them by their situation and their 
rounded aspect, like "marbles." 

Against the carpal thoroughpin, lines or fine points cauterization are 
used, with or without the puncture by the trocar. lodined or phenicated 
injections, made aseptically, form a good treatment. The few accidents 
mentioned are due to errors during the operations. Blisters are not advis- 
able, as rebel cutaneous fissures of the fold of the knee may follow. The 
free puncture with the cautery (Bruche) is now rightly ignored. 

Dropsies of the anterior tendinous sheaths rarely produce lameness. They 
are treated by fine points cauterization or by irritating infections (Dupon). 
Puncture with bistouri (Dard) is liable to complications. 

IV. — Sheath of the Large Gluteus. 

This very rare affection is the result of violent contractions of the gluteal 
muscles, or of the stretching of the tendon when the animal, in falling,. 
for instance, has his leg engaged under him. 

The " dog-walk," body slightly curved sideways, the sound leg carried 
forward (Giinther) , the shortening of the step in the lame leg, flexion of 
the joints when the animal is at rest ; all those are signs that do not belong 
exclusively to that lesion. The local signs are, as Moller says, a marked 
sensation of crepitation (crepitant tenosynovitis) ; later atrophy of the 
muscles ; those are the true diagnostic signs. 

In recent and slight cases, recovery may occur rapidly by rest and con- 
tinued refrigeration. If the disease has a tendency to become chronic, 
or if it is already of long standing, blisters, lines or needle cauterization 
are indicated. When the atrophy of the muscle is marked, there remain 
little chances of recovery. Sometimes the inflammation of the bursae is 



CHRONIC SYNOVITIS — DROPSIES. 



339 



complicated with periostitis of the trochanter, osteophytes develop, the 
parts are swollen, the lameness is excessive (Williams). Against this com- 
plication, all treatment fails. 

V. — Sheaths of the Hock. 



The synovials which belong to the joints of the hock, and assist in the 
sliding of the tendons, are often affected with dropsy. There are the tarsal, 
cunean, calcanean and the pretarsal thoroughpin. The latter is formed 
by the distension of the synovials of the extensor of the phalanges. 

The tarsal thoroughpin, due to 
the dropsy of the tarsal sheath, is 
observed on animals which do hard 
work. It is characterized by three 
swellings having a constant situa- 
tion : two, supratarsal, result from 
the distension of the superior cul 
de sacs of the synovial, in the hol- 
low of the hock, between the ten- 
don Achilles and the perforans; 
the internal is generally more de- 
veloped than the external. The 
third, metatarsal, surrounds the 
flexor tendons, in the upper third 
of the cannon ; it forms a monili- 
form dilatation, not very apparent 
on account of the resistance of 
the tissues that cover it ; some- 
times it resembles somewhat the 
jarde (the curb). Tarsal thorough- 
pin may assume enormous dimen- 
sions. It has been seen with such 
proportions that, during walking, the skin which covers the internal swell- 
ing rubs and chafes against the hock of the opposite side. The diagnosis 
is doubtful only when both the articular and tendinous synovials commu- 
nicate together. 

Cooling and astringents have been used ; but the recoveries which they 
seemed to have given were specially due to the long rest given with them. 
When the thoroughpin is recent, blisters and the various liniments ought 
to be tried ; but with old and large thoroughpins, cauterization is the. 
classical treatment, either in lines or in deep points. In 1830 already,. 
Dard punctured these dilatations with the straight bistouri and applied 




Fig. 82. — Tarsal thoroughpin. 



340 VETERINARY SURGICAL THERAPEUTICS. 

afterwards a compressive bandage. Roettger made a free opening with the 
bistouri and covered the hock with a blistering preparation. These 
primitive modes must now give way to aseptic puncture with the trocar, 
which renders the action of firing more certain. 

lodined injections have been frequently used in the treatment of tarsal 
thoroughpin. Almost all those that have used them are unanimous in 
their praise. The internal growth being the largest, it is ordinarily oa 
that side that the puncture is made, after casting the horse on the affected 
side ; it can also be made on the outer side, the animal standing or placed 
in the stocks. Bouley, Barry, Rey, Knoll, Verrier, Abadie, Dupon have thus 
cured enormous thoroughpins that had resisted firing ; we have also obtained 
good results with this treatment and can recommend it. But yet the opera- 
tion is without danger only when it is done antiseptically. The ordinary- 
precautions are not sufficient, as proved by the failures of Pressecq and 
of Verrier, who, however, operated with all the caution possible before 
antisepsy was known. Pressecq clipped the hair and punctured the tumor 
with a trocar having a silver canula ; the tincture of iodine was mixed with, 
an equal quantity of water ; the operation was complicated with suppurative 
synovitis. Verrier used the iodine solution to the third; he also had 
suppurative synovitis. With strict asepsy, these accidents are not to be 
feared. 

It is to the complication of an operation that is due the discovery of a 
new therapeutic process. Biot, in puncturing a tendinous thoroughpin 
of the hock, had a profuse hemorrhage ; he had to withdraw the canula, 
and to close the wound with the bleeding knot used in phlebotomy ; the 
tumor was filled with blood and thus transformed into true hematocele. 
The horse was left to rest for several days and then put to work ; three 
months after the operation, the thoroughpin had entirely disappeared. A 
little time later, having a similar lesion to treat in a cow, this veterinarian, 
opened the corresponding saphena vein, and after emptying the thoroughpin, 
filled the synovial sac with blood. Fifteen days after the operation, the 
tumor was hard, painless and not fluctuating. Three months later, recovery- 
was complete. These cases of therapeutic hematocele are very interesting, 
but they do not seem to us free from danger. At any rate, it is better to 
wait for more numerous results. 

Line, fine points or needle cauterizations, iodined injections when 
firing fails or when blemishes are to be avoided ; such is, for the present, 
the best therapeutics of thoroughpins. 

Cunea7i thoroughpin is the dropsy of the synovial which assists the 
sliding, on the inner face of the hock, of the cunean branch of the flexor 
metatarsi. At the place of spavins or a little above its ordinary seat, it 
forms a small olivary, fluctuating tumor, whose diagnosis is very easy. 



CHRONIC SYNOVITIS — DROPSIES. 34I 

This thoroughpin is without gravity. Blisterings being unsuccessful, 
deep cauterization must be resorted to. One may also, without fear of 
complication, open the sheaths with the bistouri, making an incision 
parallel to the cunean tendon. 

The calcatiean thoroughpin, due to the dilatation of the synovial cap- 
5ula which assists the sliding of the tendon of the perforatus over that of 
the gastrocnemius and the apex of the os calcis, is characterized by an 
elongated, cylindroid tumor, extending from the summit of the hock 
upwards more or less along the tendon. Sometimes there are two 
parallel dilatations. If interference is necessary, deep cauterization and 
irritating injections are indicated. Incision is dangerous ; if suppuration 
occurs, a diffused inflammation takes place and serious complications are 
to be feared. 

As they pass on the anterior face of the hock and of the superior 
metatarsal region, the tendons of the extensors of the phalanges are lined 
Avith synovials, which are often the seat of dropsical conditions. According 
to one or both of the sacs being affected, there exists, on the antero- 
external face of the hock and of the superior portion of the metatarsal, 
one or two cylindrical dilatations, more or less soft, located alongside the 
tendons. These are often communicating together, and in this case the 
tumor is diffuse and more or less prominent. Sometimes both hocks are 
affected. 

These thoroughpins seldom give rise to lameness ; it is better to leave 
them alone. Irritating injections and needle cauterization are the best 
means to treat them. Rebel cases are treated with puncture on their 
lower part, drainage and antisepetic injections of the sac. 

VI. — Sesamoid Sheaths. 

Tendinous windgalis are formed by the distension of the great sesamoid 
sheath. They constitute above the sesamoids, along the tendons of the 
flexors, rounded or ovoid swelling, varying in size and consistency, rarely 
extending beyond the button of the small cannon bones. Situated more 
posteriorly than articular windgalis, they extend as high along the tendons. 
At times the dropsy is well marked only on one side — the w-indgall is 
simple ; most generally, the external and internal dilatations are of the same 
size — wmdgalls are called chevilles (predged) ; sometimes, immediately 
above the great sesamoids they mingle on the back of the tendons and 
form the circled windgalis. Frequently there exists also in the fold of the 
coronet, on the lateral faces of the tendons and on each side as well as on 
the median line, several small dilatations. 

Numerous treatments have been recommended against tendinous wind- 



342 



VETERINARY SURGICAL THERAPEUTICS. 



galls. At the beginning and in young subjects, rest, turning out to pas- 
ture or moderate exercise, astringent compresses, flannel bandages are- 
generally sufficient. Later on, blisters, mercurial ointment, that of bichro- 
mate of potash or lines, fine points or needles firing are indicated. 

Dard has recommended the puncture with the 
bistouri (1831) and Macheras also; the latter in- 
troduced in large windgalls, a " tent of cotton." 
At the Alfort Clinic, Bouley and Prudhomme have 
resorted to puncture with blistering application. 
In 1844, Rey associated the puncture with the 
alcoholized injection, a friction of iodide of lead 
ointment and pressure with splints. Puncture is 
harmless only when performed antiseptically. It 
must always be followed by fine points firing or 
by iodined injections. Leblanc, Barry, Rey, 
Festal, Porel, Liard, Dupon, Reul have had suc- 
cess with it. The unfortunate results of Bouley, 
Lafosse and Verrier can be explained only by the 
want of complete aseptic measures. 

When windgalls are old, have resisted firing 
,w and alterative injections and give rise to lameness, 
"-1 disabling the horse for his work, median or sciatic 
. urotomy may be resorted to. Moller has ob- 
•■^ tained good results with them. Some cases have 
jpig, 83.— Windgall of the been followed, after a variable time, with elonga- 
great sesamoid. ^^qj-^ ^f ^^g flgxor tendons. 

If synovectomy is to be attempted, it must be only with the greatest at- 
tention to the rules of antisepsy. 

To resume, recent windgalls must be treated by rest, cold compresses, 
massage and pressure. If they give rise to lameness, blister ; in cases of 
failures, lines, fine points or needles firing with or without puncture ; or 
again, intra-synovial injections with all antiseptic cares. For very old 
windgalls, rebel to the preceding methods, neurotomy. 

Chronic synovitis of the gre'at sesamoid is often accompanied with 
lesions of tendons (Barrier) or of the sesamoid bones, analogous to those of 
the plantar aponeurosis and small sesamoid sheath in naviciilar disease 
(Brauell, Moller, Marcher). Ordinarily in these cases, both bones are dis- 
eased ; though sometimes only one. Brauell has found the flexor tendons 
united to the bones. According to Marcher, cauterization may give rehef 
in those cases. 

Dropsy of the small sesamoid sheath is rare. Its treatment is that of! 
navicular disease. 




CHRONIC SYNOVITIS — DROPSIES. 343 

VIL — Sheath of the Anterior Extensor of the Phalanges. 

Formed by the dropsy of the synovial which assists the sHding of the 
tendon of the anterior extensor of the phalanges on the anterior face of 
the fetlock, this windgall, called hygroma by some, is manifested by a soft, 
fluctuating, painless tumor, clearly bilobulated by the tendon of the ex- 
tensor, when it is of large size. More common in hind than in fore legs, 
it is seldom accompanied with inflammatory symptoms or lameness, but it 
is difficult to obtain its dissolution. 

Cool applications, pressure or even blistering 
can be used only against recent and small wind- 
galls ; at any rate, the results are only incom- 
plete. Cauterization even is not always suffi- 
cient ; often we have seen the tumor resist to 
numerous and closed penetrating points, yet this 
treatment often succeeds for windgalls of small 
size. 

Simple puncture with the trocar is without 
'effect ; the tumor subsides temporarily and soon 
returns by a new distension of the bursse. Seton 
run through, under the tendon, brings on recov- 
ery by suppuration of the pocket. Free incision 
acts in the same way. Rosenbaum, after having 
failed with several blisters, made an incision two 
inches long : suppuration formed, the wound 
cicatrized and finally the tumor grew smaller. 
According to Rey, iodined injections is the best 
treatment. He says " this treatment has always 
given us success, without leaving any apparent 
mark ; it has specially the advantage of prevent- 
ing the return of the affection." Out of some 
hundred horses treated at the clinics of Lyon, 
with iodined injections to the third, only ten 
failures were observed and not one complica- 
tion. Sometimes, however, there was a large 
swelling of" the fetlock and some abscesses of 
the subcutaneous tissue. Upon a first case 

treated with iodine pure, Verrier observed, for eight days, swelling and 
some pain ; two months after there remained no indication of the trouble. 
In a mare with a windgall of the hind fetlock, he used the same treatment; 
the result was the same ; the animal was laid up but a few days ; two 
months later the tumor had disappeared. Some time after, the treatment 




Fig. 84.— Windgall of the 
hind fetlock. 



344 VETERINARY SURGICAL THERAPEUTICS. 

•was again used in a windgall of the fore leg. A suppurative synovitis oc- 
curred, which lasted a long time and ended in ankylosis. Notwithstanding, 
the animal was able to work. Anatomy tells us that the bursse of the an- 
terior extensor pedis communicates with the articular synovial of the fet- 
lock ; this explains the possibility of complications similar to that of Ver- 
rier. Nevertheless, the cases of Rey tend to show that these accidents are 
Tare, and to avoid them, one must assure himself that such communica- 
tion does not exist. If it does, it is prudent to ignore the iodined injec- 
tion. Strong phenic acid gives as good results as the iodine. Whatever 
ingredient is used, the injection must be followed by slightly compressive 
"bandage, extending from the foot to the middle of the cannon. It is 
sometimes necessary to obtain recovery to resort to free opening and 
curetting of the pouch. 



CHAPTER VI. 
APONEUROSIS. 

Solutions of continuity of the aponeurosis — wounds or ruptures — ordin- 
arily heal without complication where care is taken to prevent infection. 
Aponeurotic dieresis, which are necessitated with median or sciatic 
neurotomy, cicatrize rapidly. Muscular hernias may take place in some 
regions ; at times an opening, buttonhole-like, remains in the aponeu- 
rosis ; at others a fibroiis band attaches the muscle to the edges of the 
torn membrane. 

The retraction of the aponeurosis of legs has been the object of numer- 
ous observations. Most commonly, it is due to secondary phenomena 
brought about by various morbid conditions. After Delafond, some 
authors, Eichbaum and Dieckerhoff among them, considered this retraction 
as the producing cause of various affections ; retraction of the tibial aponeu- 
rosis gave rise to springhalts ; that of the band of the coraco-radialis to 
spring knee ; that of the reinforcing bands of the aponeurosis of the per- 
forans plays a part in the development of knuckling and clubfoot. Some 
lameness of the anterior or posterior extremities, as well as some anom- 
alies of action, are produced by the same causes. Gavard has related the 
observation of a mare that was very lame and which was cured by the 
subcutaneous section of the aponeurosis of the fascia lata. One morning, 
this animal, which had already had several slight attacks of lameness, 
was found unable to move ; " the right leg, stiff as an iron bar, did not 
rest on the ground ; ... it is impossible to move the leg or any part of 
it, and the manipulations made to that effect are very painful to the 
animal." In front of the thigh was observed a wide ribbaneous band, 
stretched to excess, and above the stifle there was a painless, soft effusion. 
This band was divided transversely in about its middle, the animal stand- 
ing. " Immediately, the animal recovered the freedom of his movements ; 
he walked without difficulty." ' 

On account of their inextensibility and great resistance, aponeurosis 
often give a peculiar aspect to the inflammation existing in the tissues that 
they cover. Preventing their development, they give rise to violent pain, 
interfere with the circulation and produce an ischemical condition which, 
if continued, promotes gangrenous accidents. When suppuration occurs 

1 Gavard, Journ. de Med. Vet., 1893, page 584. 

345 



346 VETERINARY SURGICAL THERAPEUTICS. 

in those tissues, pressure by the aponeurosis ordinarily makes the pus 
migrate alongside the connective layers, until it finds a place for escape ; 
sometimes aponeurosis are perforated by the necrotic fluid ; then, almost 
always the opening of communication of the sub and susaponeurotic infil- 
trations is very small and it becomes necessary to make a free incision 
or a counter opening. The incision of aponeurosis is made as much as 
possible from inward outwards, with the bistouri guided with the grooved 
director, bearing in mind the presence of blood vessels and nerves. 
Sometimes the operation is not without danger ; the tissues being indur- 
ated, the instrument must be introduced deep. In the region of the 
flank, the peritoneum is not the only danger ; Blanc, in operating on a 
horse, had a mortal hemorrhage.' 

Submitted to the long action of pus or injured by a soiled wounding 
object, the closed, little vascular tissue resists badly against infection ; 
often a more or less extensive part of it becomes mortified, and once 
established in the aponeurotic structure, necrosis spreads little by little, 
as it does in tendinous tissue, in the scutiform plate, giving rise some- 
times to very severe disorders, to numerous fistulas and abundant sup- 
puration. This march is that of most necrosis affecting the aponeurosis 
of the withers, the back, croup, flank or lower abdominal wall. In a 
horse affected with necrosis of the aponeurosis of the flank, following 
a puncture of the caecum, we had to make three successive counter open- 
ings, the last one far away to the inferior part of the abdomen, and not- 
withstanding a most careful treatment, recovery did not take place for four 
months. The indications for all those necrosis are the same ; free incis- 
ions or counter openings, introduction of tents or drains to insure the flow 
of pus, repeated injections of strong antiseptic solutions (phenic acid, 
creoline, chloride of zinc, Villate solution, tincture of iodine). 

1 Blanc, Bullet. Soc. Med. Vet. Prat., 1S95, page 45. 



CHAPTER VII. 

ARTERIES. 

I. 

WOUNDS. 

In general, arterial wounds exist in connection with solution of con- 
tinuity of the tegument ; this condition is sometimes missing, as in the 
case of wounds made by swallowed foreign bodies ; those may reach the 
aorta and in their migrations through the tissues injure large arterial or 
venous vessels. If the lesion is very small, there is no hemorrhage ; the 
anatomical elements, separated for one instant, retract after the passage of 
the wounding body ; repair takes place by first intention. More commonly 
there is hemorrhage ; at times — specially if the artery deeply situated 
communicates with the exterior by only a narrow tract — the hemostasis 
takes place rapidly by the formation of a thrombus, " wedge-like," which 
separates the external coat in the surrounding of the opening, depresses 
slightly the internal membranes and obliterates the wound. Circulation 
goes on in the wounded blood vessel; a consecutive aneurism is excep- 
tional in animals. (Renault.) 

The carotid or the saphena are the vessels which, in most of the obser- 
vations of ariertal.punciures, are spoken of (during phlebotomy) ; in a few 
it is the aorta or one of its divisions. In performing puncture of the 
vagina in ovariotomy, if the point of the bistouri reaches one of the large 
arteries of the pelvis, the blood escapes in the peritoneum ; no pressure 
being applied on the vessel, death occurs in a few minutes. With a 
therapeutical object, punctures of arteries have sometimes been performed 
(acupuncture, electro puncture) ; but in these operations the point remains 
a certain time in the interior of the vessel and insures the obliteration. 
The experiments of Velpeau have demonstrated the coagulating action 
of foreign bodies. 

Wounds with sharp ins/rufttents 2Ci& pejietrating or non-penetrating. The 
latter are not serious ; whether they run through the sheath only or extend 
to the middle coat, they seldom, in animals, expose them to the forma- 
tion of aneurisms. 

Penetrating wounds divide the vessel completely or incompletely. Large 
arteries entirely divided by a transverse section give rise to such abundant 

347 



348 VETERINARY SURGICAL THERAPEUTICS. 

hemorrhage that death occurs before any repairing work can be started. 
In arteries of medium size, deeply situated and communicating externally 
by only a narrow orifice, hemostasis may take place naturally. In such 
cases, both extremities of the divided artery retract in their cavity as 
would the ends of a stretched elastic tube, when divided ; the open 
mouths of the vessel shrink, the blood infiltrates in the sheath and the 
surrounding tissues ; an external clot is formed first, then coagulatioa 
spreads to the interior of the arterial ends and gives rise to an hitej-nal clot, 
more or less elongated, generally extending to the first collateral. To 
insure complete hemostasis, this clot must organize. From the arterial 
wall and the edges of the wound, true vegetating endarteritis is started, 
whose granulations penetrate the structure of the clot and transform it 
into a fibrous tissue which in time retracts : to such an extent that after a 
certain time the divided extremities represent only fibrous cords, united 
together by a tractus of similar nature. All danger of hemorrhage is re- 
moved as soon as the clot is sufficiently organized ; but at the beginning^ 
when it is still fibrinous, an external violence, a strong rush of bloody 
current, a somewhat active inflammation of the coats of the vessel, are 
sufficient to bring on a new hemorrhage, whose serious nature will be 
proportional to the importance of the vessel. 

Spontaneous hemostasis takes place so much more rapidly that the 
animal's blood is " more plastic." In relation to this, dogs occupy the 
first place ; then come cattle, sheep, and, far behind, the horse. In 
dogs, the transverse section of the carotid is not always fatal. 
Surgical practice shows that " hemorrhages due to transverse sections of 
large muscular arteries, as in those of the neck, of the withers, chest and 
croup in horses, either stop spontaneously or are easily controlled by 
hemostatic means of secondary powerful influence." (Bouley.) 



Fig. 85. Fig. 86. Fig. 87. 

Wounds of the Arteries. 

Incomplete sections are transverse, oblique or longitudinal. In almost 
all, spontaneous hemostasis is possible. If the wound, transverse or 
cblique, is narrow, the phenomena are similar to those of punctures. Aa 



WOUNDS. 349 

hemostatic wedge, with base outwards, whose point is between the two edges 
of the wound, stops the flow of blood. In a large wound, involving more 
than half the circumference of the vessel, the edges gape apart by the 
retraction of the elastic fibers ; the wound assumes an oblong form which 
favors trie hemorrhage — the divided ends no longer able to retract in the 
depth of the tissues, the constant push of the bloody current prevents the 
formation of an obliterating clot. Lotigitiidinal wounds are the less 
dangerous. There is no marked separation of the edges ; repair goes on 
as in pricks or in punctures. 

In contused woiaids, arteries may be divided cleanly, as in wounds with 
sharp instruments. Sometimes the internal and middle coats rupture 
first ; the external favor the hemostasis by its stretching. Projectiles 
give rise to lateral wounds, perforations or complete divisions. In the 
tearing of arteries, the coats of the vessel stretch, then the internal tears 
first ; if the stretching continues, the middle coat then gives away and 
then comes the external. When the artery is of small size, there is no 
escape of blood : the inside and middle coats are covered by the external, 
which has stretched much before giving away ; the tearing completed, 
both ends of the artery retract, especially the middle coat, and the ex- 
ternal membrane, less elastic, covering the two stumps of the vessels con- 
stitute a kind of cork which arrests the blood ; an effect similar to that 
produced in torsion or section with the ecraseur. 

A widely open arterial wound is always characterized by a rutilant hem- 
morrage whose force of current is so much more marked that the vessel is 
nearer to the heart ; the beatings of this organ being manifested upon the 
flow of blood by jerks isochronous to the ventricular contractions. When the 
external wound is narrow and sinuous, the fluid runs out yet freely, but it 
is not pushed out so far. With the exception of wounds by tearing, 
arterial divisions are always accompanied by an hemorrhage csWed primitive. 
When arrested spontaneously or by treatment applied against it, some- 
times the flow of blood reappears after a few days, either through the 
exploration of the wound or softening and disaggregation of the clot ; this 
hemorrhage is called secondary. 

To arrest the flow of blood, such is the only indication of arterial 
Avounds. For a long time old surgery depended on the use of astringents, 
styptics, cooling preparations. Cold water and ice have never arrested a 
serious arterial hemorrhage, and even the classic chloride of iron does not 
deserve the reputation made for it in veterinary surgery : it promotes the 
formation of a clot where infectious germs pullulate, and if, after its use, 
the surgeon wants to secure the strings of the blood vessels, they are very 
difficult to find. For hemorrhages in sheet, cautery is the best. If the 
lesion is on a leg, a temporary hemostatsis may be made with digital 



:35o 



VETERINARY SURGICAL THERAPEUTICS. 



pressure or the tourniquet. Permanent hemostasis is obtained by antiseptic 
plugging, torsion, ligature or forcipressure. 

Compression in the wound demands minute asepsy. In legs, the 
wound, made bloodless by the use of the tourniquet or ligature en masse 
of the region, should be plugged with iodoformed gauze or antiseptic 
wadding. A wadding dressing will complete the operation. After five, 
six or eight days, under the gauze, softened with tepid water and removed 
with care, will be found a dry, granulating surface ; the after cares are 
the simplest. 

y^iX!^ forceps iox forcipressure, it is generally easy to secure the ends of 
the divided vessel. If ligature appears difficult, if the instrument is well 
aseptic, it can be left in the wound and enveloped in the dressing. It is 
removed after forty-eight hours. 

Torsion, defended of late by Tillaux, deserves to be used for small 
arteries. With the forceps, the arterial stumps are twisted ; the internal 
and middle coats shrink, the remaining external covers the extremities and 
stops the blood. (Figs. 88 and 89.) 

Ligature is the most certain of all means. 
Large vessels must be tied at both ends. With 
a complete section, the extremities are retracted 
in the interior of the tissues ; one must not 
hesitate in cutting those to expose them. As 
ligature, catgut or silk is used ; the essential is 
that it should be aseptic. Catgut is resorbed, 
silk incysts, and the tissues tolerate it without 
reaction. Ordinarily, the ligature of the central 
end is not sufficient ; even when the peripheral 
end seems to be bloodless, it must be looked 
for and secured, as the small clot that obliterates 
it would not resist collateral circulation ; sec- 
ondary hemorrhage might occur. 

The effects of ligature of arteries are known : 

the internal and middle coats break and retract ; 

the blood coagulates in variable extent in both 

stumps ; after a few days the strangulated ex- 

The endarteritis promotes an active cellular neo- 




I?ig. 88. Fig. 89. 

Torsion of the arteries, 

(Tillaux.) 

ternal coat gives way. 



formation, filled with capillaries starting from the walls of the vessel ; the 
organization of the clot brings a lasting hemostasis. 

To supply the circulation of the ischemied surrounding, collateral blood 
vessels develop and prevent gangrene of the tissues formerly irrigated by 
^he now obliterated blood-vessel. 

With simple arterial puncture, one may often dispense with the ligature ; 



RUPTURES. 351; 

pressure is sufficient. When a large bloody tumor is formed, pressure of 
the vessel toward the central end has been recommended : it can be used 
for some arteries. If, however, the enlargement continues so as to en_ 
danger the conservation of the tegument, it is better to cut freely and 
ligate the two divided ends of the vessel. Puncture of the carotid in the 
horse has for a long time been considered a serious accident. But the 
observations related by Favre, Bareyre, Delafond, Rainard, Cabaroc, Rey, 
Mangin, Dayot, Prang^, Roux, have shown that generally the hemorrhage 
can be controlled by the application of one or two pins on the wound of 
phlebotomy, in taking hold of a sufficient quantity of skin and making on the 
surface of the tumor a permanent pressure, with the aid of pads of oakum 
soaked in cold water and held in place by splints and bandages. The 
blood filtrates more or less abundantly in the jugular groove ; a diffuse 
aneurismal hematoma is formed, which disappears ordinarily in eight 
days ; sometimes this is enormous, and then pressing upon the trachea 
brings on death by asphyxia (Rainard, Loucou). In the observation of 
Van Autgarden, the roaring was such that the author had to perform 
tracheotomy. These are exceptional cases. Ordinarily the resolution of 
the tumor goes on little by little, the arterial wound cicatrizes, the current 
of blood is preserved ; a secondary aneurism seldom follows. Noquet has 
observed a case of this kind in a cow where the saphena artery had been 
pricked during bleeding at the vein ; hemorrhage had stopped after the 
closing of the wound with two pins ; there was a thrombus as big as an 
egg. A month later, the tumor had the same dimensions ; it was punc- 
tured, an abundant quantity of blood escaped ; a new suture was applied, 
the pins sloughed out, which was followed by a mortal hemorrhage. 

Ligature of the carotid has been recommended by Montier, Segretain 
and others. Quite delicate, it is not without danger of complications. 
One must not resort to it unless the hemorrhage is very abundant or if 
the extravasation, voluminous, interferes seriously with respiration.' 

11. 

RUPTURES. 

Ruptures or subcutaneous tearings of arteries have for ordinary causes 
traumatisms, comminuted fractures, luxation, muscular efforts, vomiting, 
the action of veratrine (Hering), and certain manipulations of the surgeon 

1 J. E. Erown has related the case of a three months colt which was homed by a 
Jersey bull and which had received a lacerated, contused wound with division of the 
carotid artery, jugular vein and pneumogastric nerve. Ten inches of the artery was 
left hanging to the wound, with ten or twelve inches of the nerve and five of the 
vein. The artery was ligated, the protruding ends of the artery and nerve were cut off. . 
Recovery was perfect. — American Vet. Review, vol. xv., page 279. 



352 VETERINARY SURGICAL THERAPEUTICS. 

to reduce fractures and dislocations. Embolics may also soften arteria^ 
coats and promote rupture (Cad^ac). In the great majority of cases, 
alteration of the vascular walls (atheroma, aneurisms) has been ob_ 
served on a level with the rupture. Some cases, however, prove the possi- 
bility of rupture of vessels whose walls present no lesion of degener- 
ation. When it occurs in a superficial artery, a diffuse, warm tumor forms 
at once, irregular and pulsating as aneurisms do, though not so powerfully ; 
seldom can the bellow murmur be detected in them. This bloody effu- 
sion, called diffused o?- false aneurism, is not an aneurism. The name of 
diffuse ajieurismal hefuatofna, proposed by Michaux, is to be preferred. 

The large arteries of the thorax and abdomen rupture more frequently 
than superficial vessels. Sometimes it is the pulmonary artery (Hering, 
Hartmann, Prietsch). At the post-mortem of a dog, that had died sud- 
denly, we found a large distension of the pericardium by blood ex- 
travasated through two little tears situated on the right face of the pulmonary 
artery. In the zone where the tears were, the artery was very thin and 
presented several small transparent spots. But, no doubt, it is the aorta 
which is injured in the greater number of cases. Larcher has reported 
twelve observations at the Societe Centrale de Medecuie Vcterinaire (1876). 
In all, the tears had taken place at the base of the primitive aorta, at a point 
where the vessel is still covered by the pericardium ; this contained a notice- 
able quantity of blood, sometimes fluid, more generally coagulated. In five 
cases the structure of the vessel was the seat of atheromatous degeneration ; 
in two, no visible alteration could be detected ; in five others, no mention is 
made of the condition. To these twelve observations of Larcher, we 
might add those of Vatel, Maillet, Rigollat, Palat and others published ia 
other countries or recorded by us at the Alfort clinics. In horses, rupture 
of the aorta is not rare. 

If, generally, the diagnosis is only positive at the time of post-mortem, 
the accident can be suspected, taking into consideration the circumstances 
in which it takes place and the symptoms it gives rise to. The symptoms 
are those of large internal hemorrhages. " In one case, a high jumper, 
after a prodigious jump, suddenly drops on his hind quarters, to rise no 
more. In another, the horse, as he is cast on the bed to be submitted to 
an operation, makes a powerful inspiration, his eyes roll in their orbits, the 
respiration and beatings of the heart stop and immediately he is pulseless." 
(Larcher). In two cases that we have seen, the rupture took place during 
the struggling of the animal while lying on a bed for operation. The 
aorta may give way at a point some distance from the heart. At the autopsy 
of a twelve year old mare, that died suddenly in stocks, we have found a 
rupture of the aorta on its superior face, on a level with a small exostosis 
of the third lumbar vertebrse. The vessel had two ulcerations ; the 



ANEURISMS. 353 

smallest like the scratch of a nail, having sharp, ragged and sinuous 
■edges ; it occupied the entire thickness of the wall ; its bottom seemed 
formed by a fine transparent anhistous membrane. The other, situated 
like the precedmg on the dorsal face of the vessel, presented the same 
external characters ; the tear started from its bottom. 

Rupture of the pulmonary artery, primitive aorta or one of its divisions, 
ordinarily kills in a few minutes ; all attempt at interference is useless. 
With those of secondary and superficial arterial trunks, treatment may- 
be efficacious. Pressure on the vessel, on the cardiac end, may sometimes 
arrest the hemorrhage, specially if with it cold effusions and astringents 
are used. The application of a compressive bandage may also give good 
results. If, notwithstanding these, the blood continues to accumulate 
under the skin, the ends of the ruptured vessel must be looked for and 
secured with ligature. 

To rupture of blood vessels can be added the perforation of their coats 
by nemathelmintes which they may contain. This accident has been 
observed in horses with the sclerostomus armatus (Durieux) and in the 
dog by the sanguineous spiropterus (Morgagni, Degive, Megnin.)' 

III. 

ANEURISMS. 

According to the form of the arterial dilatation, aneurisms are divided 
into fusiform, when they occupy the whole diameter of the vessel, and 
sacciform, when limited to a portion of the wall only. Their origin is 
primitive or spontatieous. A bruise may divide the internal membranes 
of an artery and create a locus mirioris resistensice, where the traumatic 
aneurism takes place. Acute or chronic inflammation of blood vessels, 
atheroma, promote the formation of spontaneous aneurisms. Endarte- 
ritis is often due to parasites (strongyli, spiroptera). In the majority of 
horses, the great mesenteric, and at times the small and the caeliac axis 
are the seat of aneurismal lesions due to the strongylus armatus. Very 
severe colics (intestinal congestion, thrombo-embolic colics) seem to be the 
result of an infection starting from these points. Megnin has described in 
the dog two cases of aneurisms of the aorta due to the sanguinoletita. 
spiroptera. 

1 A case of rupture of the internal iliac is reported by W. J. Martin occurring in a 
mare during the manipulations made by the owner to relieve her in a case of distokia. 
The mare had received a small dose of chl»i-oform to quiet her pains but died as her 
colt was removed. At the postmortem the rupture of the artery was found just below 
the junction where it leaves the posterior aorta. — American Vet. Review, vol. xxiii, 
page 114. 



354 VETERINARY SURGICAL THERAPEUTICS. 

Aneurisms constitute a prominent danger. Wounded, they give rise to 
an abundant hemorrhage ; their rupture is generally fatal. Internal- 
aneurisms are beyond surgical interference; the external only are justifi- 
able of an active treatment ; they are rare in animals. They have, how« 
ever, been observed in horses on the palatine artery, the pharyngeal, ifiter- 
nal tnaxillary, gluteal, on various arteries of the legs ; in cattle, on the 
vertebral, ischiatic and the tibial. The observations of Blaise, Steinmeyer, 
Walley, refer to horses that have died from rupture of aneurisms of the 
pharyngeal, carotid and internal maxillary arteries. 

When, upon the course of an artery, one observes a tumor evenly fluctu- 
ating, depressible, reductile, pulsating, he must think of aneurisms. Some- 
times they are mistaken with neoplasm developed on the tract of a 
vessel. Moller has told us that he made an error of this kind and took 
a carcinoma of the neck for an aneurism. A puncture improperly made 
may be followed by the most serious sequelae ; as the case of King related 
by Percivall in his Hippopathologv : An old horse had on the croup a 
tumor of the size of a man's head ; it was fluctuating. King punctured it; 
a flow of blood took place at once ; plugging was vainly tried, the animal 
dying. Dissection revealed the presence of an aneurism, partly ossified, 
of the gluteal artery. 

In the case of the cow recorded by Collin, she had on the left side 
of the neck a soft, elastic tumor, as big as the fist, well defined, not 
adherent to the skin, without heat or pain. Mistaking it for a cyst, the 
author tapped it with a pointed red iron, which was immediately followed 
by a flow of rutilant blood, jerky, as big as the finger. A continued suture 
arrested the hemorrhage ; but the blood escaping in the subcutaneous 
cellular tissue, the tumor became treble in size, and the arterial beatings 
were readily perceptible. The treatment consisted of cold lotions. The 
size of the tumor diminished. All danger seemed avoided, when the animal 
rubbed herself against a tree, and serious hemorrhage followed. The 
animal was sold to the butcher and destroyed. She had an aneurism of 
the cervical artery. 

Spontaneous recovery of aneurisms is possible ; it takes place by 
thrombosis ; a clot is formed in the sac and closes it. The artery may 
keep its caliber or obliterate. Such termination is rare ; ordinarily aneur- 
isms assume larger and larger dimensions, disturb the surrounding tissuest 
and their possible rupture is a constant danger to the life of the patient. 
Furlanetto thought best not to interfere in two cases of aneurisms, quite 
large, of the tibial artery in steers. Both animals were able to continue 
their work. 

Various methods oft reatment have been recommended against aneur- 
isims. General depression by bleeding, low diet and purgatives (method 



ANEURISMS. 355 

cf Valsalva) is now left aside. Digital or elastic pressure (method of 
Reid) is not practicable in veterinary surgery on account of the restless- 
ness of our patients. Coagulating agents, so much in favor in days gone 
by, are now ignored. Ligature and extirpation are now the only modes of 
treatment resorted to by surgeons. 

Ligature may be applied above or below the sac, or on both at once ; 
the operation is simple. Aseptic catgut or silk is used. The ligature 
above the sac (method of Anel-Hunter) has many advocates. As soon as 
it is made, the tumor flags down, the murmur, pulsation, and expansive 
movements cease ; the region becomes cold. The circulation through 
the collaterals is generally sufficient to prevent the gangrene of the re- 
gion where the ligated vessel carried the blood ; still there is a possibility 
of this dangerous complication. A clot closes the sac. Under the in- 
fluence of the collateral circulation, the blood reappears in the tissues, in 
the sac itself, and the passive clot is transformed into an active clot. The 
recovery thus requires : " (i) the temporary arrest of the circulation and the 
formation of passive clots; (2) the graded return of the circulation, allow-, 
ing the transformation of the passive fibrino-globular clots into active^ 
fibrinous." (Michaux.) 

Double ligature, above or below the dilatation, is used as much as the 
preceding. In the horse. La Motte has cured with it an aneurism as 
big as a chicken's egg, situated on the poll, behind the ear, and developed 
on the posterior cervical artery. In a similar case, Peters has also beea 
successful with the same treatment. 

Extirpation of the sac between two ligatures is considered by some 
surgeons (Trelat, Delbet) as the choice mode of operation. It is more 
complicated and requires more division of tissues than ligature, but it is 
radical in its effects ; it removes the possibility of return and does not 
expose to the suppuration of the sac. 

One may be called to treat a hemorrhage due to the opening of an 
aenurism. Reimers had a similar accident in a steer which had a tumor 
on the croup ; the bleeding was stopped by plugging and perchloride of 
iron. In some cases, interference must be applied as quick as possible. 
Plugging, iodoformed gauze, double ligature or extirpation are indicated. 

ARTERIO- VENOUS ANEURISMS. 

In these, there is an accidental or spontaneous communication between 
an artery and a vein. Traumatisms are generally the cause. It has 
occurred in man quite often by bleeding with the lancet. The arterial 
blood, with its pulsating force, enters into the vein and distends it. A soft 
tumor is formed, whose characteristic symptom is the vibrating trem- 



356 VETERINARY SURGICAL THERAPEUTICS. 

bling, the thrill of English authors. " This peculiar trembling is observed 
and also heard as well as it is felt by the touch ; it is composed of a sound 
and a vibration. This sound and vibration are continued and are increased 
in connection with the cardiac systole ; they are perceived especially at the 
level of the tumor, where they are greatest, but they can be detected at 
some distance from it. . . . The sound of this thrill has been compared 
to the buzzing of a bee, the purring of a cat, the whizzing of a top, of a 
mill, to the noise of the red iron dipped into water. . . . The vibration 
is so characteristic that, felt once, its character and nature are never 
forgotten." (Michaux.) 

Cagny has described an arterio-venous mesenteric aneurism. The 
cases of Chauveau, Collin, Nocard, Moreau, are interesting. In the 
first, it was a tumor, as big as an egg, situated along the course of right 
maxillo-muscular artery and vein, outside and a little back of the inferior 
jaw. This tumor, easily reductile, would return as soon as pressure 
ceased ; the hand felt in it a very strong pulsation, isochronous to the 
systole of the heart; the vibrating thrill was readily perceived. At the 
post mortem, the tumor was found to exist on the tract of the vein and 
communicated with the artery ; it measured eight centimeters in length 
and about four in width. Both vessels were dilated at the seat of the 
aneurism.' 

The case of Collin relates to a young steer, castrated ten months be- 
fore by a gelder. Both cords had been twisted and then torn. The 
animal presented in the scrotal region, a tumor, egg-like, indolent, very 
soft and elastic. " In pressing it gently, one could feel the beatings cor- 
responding to the cardiac systoles ; to which succeeded without interrup- 
tion, well marked and characteristic vibrating thrills." When the subject 
was killed, at three years old (thirty- two months after castration), the 
tumor measured from fifteen to twenty centimeters in height and about 
thirty in circumference. The dissection, made by Lesbre, showed that it 
was produced by the great testicular vein and artery enormously dilated, 
elongated and communicating together. 

In a fifteen year old gelding, Nocard found a soft, elastic tumor, as 
big as the fist, occupying the left side of the sheath, some centimeters 
back from its anterior opening. It was the seat of beats isochronous to 
the arterial pulsations, and each of these was followed by a series of vibrat- 

^ In the case of H. D. Hanson of a horse that had died during an attack of colics, 
lie found at post mortem : " a large growth of the size of a cabbage head, of hard 
consistency, situated in the lumbar regions towards the base of the caecum, which on 
being removed proved to contain a large abscess in its center communicating with 
the ileocaecal artery and involving the right fasciculus of the great mesentery." 
— Amer. Vet. Review, vol. xix., page 706. 



ARTERITIS AND THROMBOSIS. 357 

ing thrills. The external pudic artery communicated with a large venous 
•division of the sheath. 

In subjects of the bovine species, Moreau has seen two arterio-venous 
aneurisms of the face developed on the course of the facial artery and vein. 
In one, there was also exophthalmy, due to the dilatation of the ophthalmic 
Areins. 

Where surgical interference is decided upon, bloody manipulation, with 
strict antisepsy, forms the proper treatment. The double ligature of the 
artery above and below the sac must be applied on the aneurismal varix. 
In all the other cases, both ends of the artery and of the vein must be 
ligated (Delbet). If the sac is large, ligature must be followed by extirpa- 
tion (Trelat). In cattle, Gurlt, Prinz, Meyer, have treated by excision 
the arterio-venous aneurism of the great testicular without any accident 
iollowing. 

IV. 

ARTERITIS AND THROMBOSIS. 

Any inflammation existing in the tissues surrounding an artery, may 
■spread on it and give rise to serious lesions. Some arteritis are embolical 
in their nature ; others start in the course of infectious diseases, progress 
quietly and become manifest only much later on, by functional disturb- 
ances due to secondary thrombosis. 

Obliterations or arterial thrombosis deserve a special study on account 
of their peculiar symptoms. Assisted by the diminution of the circulatory- 
current (Virchow), the principal part in their formation is due to arteritis 
and embolies. The clot may be parietal, incompletely close the caliber of 
the vessel and diminish the circulation ; but it may also prevent it en- 
tirely. At first very thin, this clot generally develops in the direction of 
the circulatory current as far as the first collateral ; it gradually increases ia 
size ; sometimes the vessel which contains it is bosselated. Its color is 
yellowish or reddish, its consistency more or less firm ; it seems formed 
by layers successively deposited upon a primary nucleus. The muscles 
which receive blood from thrombosed vessels present no important altera- 
tion ; yet Bouley Jr. has found them " pale, discolored, and less consistent 
than in normal state." 

Besides traumatic thrombosis, arterial obliterations are frequently found 
in horses ; their pathogeny is yet uncertain. Thrombosis of the posterior 
aorta is most common. Some authors, Goubaux among them, have ac_ 
cused the laceration of the walls of the aorta, produced at a moment whea 
the animal made a bad slip. But it is probable that these thrombosis 
originate most commonly from infectious causes. 



358 VETERINARY SURGICAL THERAPEUTICS. 

If their etiology is not well known, their pathology is, at least for those- 
that affect the vessels of the extremities. Thrombosis being either incom- 
plete or very slow in its development, the increased collateral circulation, 
prevents all accident of gangrene. Besides this, the bloody supply is suf- 
ficient through the muscles when at rest ; but if exercise is demanded of 
the animal, the quantity of blood that they receive is unable to insure thier 
normal functions and then occurs a true impotency of these ischemied 
muscles. At the time when the conditions of apparition of the lameness 
are realized, the region, poorly supplied, becomes the seat of an excessive 
pain ; the aspect of the animal is anxious, the great functions are accelerated. 
If the artery can be explored beyond the obstruction, it is found that the 
pulsations have disappeared ; palpation of the collateral of the canon give 
no longer the pulse. In the entire region where the diseased vessel is 
distributed, the skin is dry and cold, while it is hot and at times covered 
"with perspiration in the other parts of the body, when the exercise has been 
too long. These symptoms, added to this peculiarity, that the lameness 
occurs after a certain amount of exercise and disappears after rest, are suf- 
ficient to establish the diagnosis of arterial tJiromhosis. 

In the thrombosis of the aorta and its division the clot occupies variable 
positions : it is found in the lumbar portion of the vessel, at its bifurca- 
tion or in one of its terminal branches. The symptoms vary according to 
the location or the extent of the obliteration. When this is incomplete, 
either the gait is regular at the beginning of the exercise, or stiffness of the 
hind quarters, resembling that of sprains of the loins, is observed. More 
severe symptoms appear after a few minutes of trotting exercise : sometimes 
it is a more or less complete paraplegia, but as the lesions are always more 
marked on one side, it is more commonly a marked lameness of the cor- 
responding member. It is easy to recognize the nature of these accidents 
and distinguish them from those due to sprains of the loins, to muscular 
lacerations or diseases of the spinal cord. The increased severity of the 
symptoms by exercise, the absence of arterial pulsation or the diminution of 
their force below the thrombosis and the lowering of the temperature of the 
extremity suffice to make the diagnosis. 

Thrombosis of the brachial trunk is more rare than that of the aorta. 
Bouley, Schramb, George, Guntherberger, Weinberg, Moller, have re- 
corded cases of it. The patient of Bouley had regular movements at the 
beginning of the exercise ; after five minutes, he was lame on the left- 
foreleg; after fifteen minutes, it was impossible for him to rest his foot on 
the ground ; at the same time his respiration became accelerated and 
loud, the skin was covered with perspiration, except the lame leg. At 
post-mortem there was found an obliteration of the brachial trunk and its 
divisions (sus-scapular, great posterior muscular, epycondiloid, anterior 



ARTERITIS AND THROMBOSIS. 359 

-and posterior radial arteries). In the observation of George, after ten 
ininutes of exercise the horse was lame on both forelegs ; " they were 
semi-flexed, scraping the ground, and seemed dumb or paralyzed. At 
that time, the respiration was very labored, the beatings of the heart bounc- 
ing ; the animal was anxious, the face contracted, the skin of the whole 
body covered with perspiration, except the two forelegs, whose hairs 
were dry and the skin cool." After fifteen minutes of rest these symp- 
toms disappeared. At the post-mortem, one found a thrombosis of both 
brachial trunks ; " the muscular structure was not discolored and presented 
nothing abnormal; it was the same with the nerves." In a seven year 
old mare, Moller has observed a similar case to that of George. Examina- 
tion of the chest revealed hypertrophy of the heart ; but at rest nothing 
abnormal could be detected in the forelegs. Trotting exercise, after ten 
minutes, brought out a general stiffness of the anterior quarters; the legs, 
the left especially, moved with difficulty, held in abduction, scraping the 
ground, the feet stumbling over the smallest obstacles in their way; the 
animal fell down repeatedly, and when up, would carry her shaking 
legs in abduction. The symptoms disappeared after five or ten minutes 
of rest, to return again after a short exercise.' 

Therapeutics is powerless against arterial thrombosis. Alcalines are of no 
use. According to Goubaux, the daily administration of 20 grammes of 
iodide of potassium has given to Pilton two recoveries in cases of intermit- 
tent lameness due to obliteration of the crural artery. New facts are 
necessary to confirm the efficacy of this treatment. We have tried it on 
three occasions without results. 

Massage of the aorta per rectum, recommended by Collin and Bayer, is 
useless and dangerous ; useless, as the clot is not disturbed ; dangerous, on 
account of the embolics its broken pieces might promote. Moller told 
us that he tried massage in a horse, and that death occurred in twenty- 
four hours. At post-mortem, with the old lesions a recent clot was found 
which obliterated the posterior aorta. 

In rare cases, recovery has occurred under the influence of exercise. 

1 Numerous cases of thrombosis and obliterations of the terminal branches of the 
posterior aorta have been recorded in America by A. Liautard, Peabody, Ambler, 
Huelsen and others. The symptoms were those described by the author. The 
lesions varied. In one case of Liautard the obliteration involved the posterior aorta, 
circumflex iliac, external and internal iliac on both sides — on the left side the clot 
was traced in the tibial arteries to the hock. In another the internal iliac only with 
its ramification was involved. In Peabody's case both iliacs were blocked ; on the 
external the clot extended to the femoral, popliteal and tibial arteries. In the case 
of Ambler it was found that the posterior aorta near its quadrification was partly 
closed by a large clot extending to the left iliac down to the femoro-popliteal. On the 
light side a clot existed also, but smaller. — American Vet. Review, vols. 4, 5 and 11. 



360 VETERINARY SURGICAL THERAPEUTICS. 

To this effect it has been recommended to trot the patients until the ap- 
pearance of the symptoms, to give them a certain rest, and another 
exercise and so on ; by these repeated restings, when the current of the 
blood is stronger and more rapid, the clot would be gradually destroyed 
or removed in a collateral branch. But there is small hope of obtaining 
such result. Progressive increase of the affection is the general rule. 



CHAPTER VIII. 
VEINS. 
L 

TRAUMATIC LESIONS. 

Non-penetrating wo2C7ids of veins are, ordinarily, not serious. Punctures 
and cuts cicatrize almost always rapidly. Bruises and denudations are 
sometimes accompanied with thrombosis, phlebitis or escharrification of the 
venous walls and then secondary hemorrhages. 

Penetrating wounds are made by puncturing, cutting or bruising objects. 
Pricks of veins, either by operations or accident, give rise to a more or 
less abundant flow of blood, varying with the size of the perforation. 
When the cutaneous opening is small, the blood becomes infiltrated in the 
perivenous connective tissue and in the cellular sheath of the vessel ; an 
hemostatic thrombus is formed. Wounds with sharp instrutnents are 
complete or incomplete. Incomplete, they are longitudinal, oblique or 
transverse ; it is with them that hemorrhage is persistent. Complete 
sections are immediately followed by a double longitudinal and circular 
retraction of the ends of the vessel, but nevertheless the hemorrhage is 
always abundant. In some cases, the central end bleeds little ; in others 
the hemorrhage is great, as when a collateral branch opens between the 
wound and the first valve of the injured vessel. Transverse wounds of 
veins may rapidly prove fatal, specially when the circular retraction of the 
ends is prevented by adhesion of the vessels to the surrounding organs 
(aponeurosis, bones) or by diseases of their own structure. Contused 
wounds have their edges either clean or irregular and ragged. The 
hemorrhage is light and of short duration. Consecutive phenomena are the 
same as in the preceding wounds ; however, they are followed more fre- 
quently with diffuse phlebitis, partial sloughing and secondary hemorrhage. 

When there is subcutaneous wou7ids, the blood collects in the peri- 
venous tissues, sometimes filtrates along the length of the vessel, in the 
musculo-aponeurotic spaces, where it coagulates. 

Wounds of veins whose walls have undergone no pathological alteration 
have a tendency towards cicatrization. In incomplete solutions of con- 
tinuity, temporary homostasis is made by a claviforra clot which spreads 

361 



362 VETERINARY SURGICAL THERAPEUTICS. 

more or less in the perivenous cellular tissue, then obliterates the per- 
foration of the vessels. If the trauma is protected from infection, cir- 
culation goes on ; sometimes the cicatricial spot dilates and gives rise to 
the enlargement that is commonly observed on the jugular of horses. 
With complete sections, the mechanism of the temporary hemostasis is 
the same ; effused blood coagulates outside the vessel, and then an in- 
travenous clot of various length is formed. 

The principal modes of treatment of venous wounds vary : siiti/re, 
pressure and pluggitjg, cauterization and ligature of tlie vessel. 

Punctures of veins are treated by pressure or suture. When the cutaneous 
wound is small, simple compression is ordinarily sufficient ; it stops the 
hemorrhage and pjrevents the entrance of air in the central end. Twisted 
or pinned suture of phlebotomy is an excellent means. The use of styptic 
substances and plugging have been recommended. Perchloride ot iron, 
much used in old times, has the objection that it promotes the formation of 
extensive clots and sometimes a severe phlebitis. Larger wounds must 
be plugged with iodoformed gauze after careful disinfection. When press- 
ure fails, forcipressure or ligating the vessel is indicated. If the wound 
is deep, to avoid much cutting, the vein can be closed with one or two 
hemostatic forceps, left in place for twenty-four to thirty-six hours. The 
best treatment for complete section of the vein, is ligature. Upon both 
ends, a silk or catgut thread is applied firmly, tied and stopped by a 
straight knot. 

The introduction of air in veins is an accident that may occur when a 
vessel of some dimension, situated in the circle of the inspiration of the 
thorax and of the heart, is open during an operation. 

A peculiar noise, a gurgling, sucking or whistling is suddenly heard, 
like that made by air entering by a small opening into the thorax of a 
living animal. Sometimes a severe dyspnea appears, the mucous mem- 
brane becomes pale, eyes are staring, pupils dilated, and death, generally 
preceded by convulsive movements, takes place after a time varying 
between a few minutes to several hours. Of the two cases recorded by 
Barthelemy, one died after seven, the other in eight hours. Some cases 
recover. Viardot had one case where lameness appeared suddenly after 
the introduction of air into the vessel. 

Yet, the introduction of air is not always followed by noticeable dis- 
turbance, and already Dupuy, Liegeard, Rey, have insisted upon the great 
quantity of air that it is at times necessary to introduce into the veins to 
kill the horse. 

The introduction of air into the veins should be avoided by applying 
pressure beyond the point where the operation is performed and relieving 
it only when the wound is closed or protected by the fingers. Frequently 



THROMBUS. 363 

this indication is neglected or imperfectly complied with, and yet no 
accident follows. In fact, it is very rare. 

When it occurs, phlebotomy is advised, pressures on the thorax, artifi- 
cial respiration. When it happens during bleeding at the jugular, it is 
lecommended to apply immediate pressure in the jugular groove, con- 
tinue to draw blood and even open another, so as to open a double way 
to escape with blood and the air it carries. (Bouley.) 

In other cases, the vein is to be closed «t once on the central end, with 
the finger or a forcipressure forceps, then have recourse to pressures on 
the chest and artificial respiration. When the severe symptoms have 
subsided, ligature is applied on the vessel. 

II. 

THROMBUS. 

Thrombus is frequent in horses after bleeding. Often, even when the 
operation is well performed, a small tumor develops at the point where 
it has been open. The formation of an extra-venous clot is certain ; it is 
the condition of the closing of the prick which has been made on the 
vessel ; but when the bloody extravasation thus produced is small and 
infectious elements are not introduced in the wound, its resorption is 
rapid. The expression " thrombus " must mean bloody tumors of some 
size, developed after a venous puncture, whose resorption takes place 
only slowly or terminates by suppuration. 

Rare in ruminants, it is common in horses. Bleeding on the veins of 
the leg, specially the axilla and the subcutaneous thoracic, are ordinarily 
accompanied with it. 

The termination of thrombus depends on the presence or the absence 
of pathogenous micro-organisms in the clot. When no infectious element 
has been introduced in the wound by the flame, the resorption of the 
bloody tumor takes place by degrees and most ordinarily it is completed 
in a few days. 

In contrary cases, it remains, inflames, becomes warm and painful ; 
soon fluctuation is detected ; the thrombus is purulent. It is possible that 
the infectious process reaches the vein, extends to the clot of the borders 
of the puncture and promotes phlebitis. The inflammation may spread 
more or less along the vein and give rise to a warm, painful swelling, 
simulating a phlebitis, and yet the circulation remains in the vessel. 

When the ligature appUed on the pin has been too tight, inflamma- 
tion of the thrombus may end in the mortification of the cutaneous 
squeezed spot ; this sloughed, the bloody tumor is widely exposed ; it 



364 VETERINARY SURGICAL THERAPEUTICS. 

suppurates and is at times complicated by inflammation of the venous 
walls. 

Thrombus are avoided on some veins by methodical performance of the 
bleeding and taking all the necessary precaution it demands ; such as 
an instrument whose length of blade is proportional to the caliber of the 
vessel, application of the pin and of the ligature without pulling of the 
skin, proper care after the operation. 

Once the thrombus is formed, one must resort to an tiphlogi sties and 
astringents : cooling applications, alum water, white lotions, douches in 
spray. At the onset pressure and irritants are injurious. Their indication 
is limited to cases where the bloody tumor remains ; then, the complica- 
tions of suppuration and phlebitis are not to be feared. 

If suppuration arises, the ligature must be removed, the wound enlarged 
to allow the escape of pus and repeated antiseptic washes made. Deep 
exploration of the suppurative center with the probe must be avoided, 
as it may give rise to phlebitis. 

In bovines, thrombus is observed on the jugular, saphena and abdom- 
inal subcutaneous. On this last it is mostly found ; it is ordinarily 
enormous and disappears more slowly than at the jugular. The treatment 
is the same as that of solipeds. 

III. 

PHLEBITIS AND THROMBOSIS. 

The relations which exist between phlebitis and thrombosis, between 
inflammation of the veins and the coagulation of the blood, have given 
rise to different opinions, and promoted numerous experimental researches. 
The question as to which of these two processes was essential and primi- 
tive has been the subject of many discussions. 

During the first half of this century, the theory of primitive phlebitis, 
as expressed by Hunter, was universally accepted. It was in 1856, that 
Virchow advanced that of the primitive venous thrombosis. For him, 
the coagulation of the blood in the vein is not a secondary alteration, 
consecutive to the inflammation of the walls of the vessel ; this throm- 
bosis is the essential and primitive phenomena of a process which ends in 
phlebitis. Thrombosis is the starting point of adhesive phlebitis ; it is also 
the first act of suppuration ; which " is a pathologic phenomena commenc- 
ing by a coagulation and ending in softening of the thrombus ; the alter- 
ations of the venous coats are secondary." Some anatomo-pathologists, 
Cornil and Ranvier among them, have continued to teach the existence 
of the primitive endophlebitis, but it must be said that the German opinion, 
as that which prevails to-day. 



PHLEBITIS AND THROMBOSIS. 365 

It has been tried to explain thrombosis in the various circumstances 
■where they take place, either by an alteration of the blood or a change in 
the structure of the venous wall. And again, successively were suspected the 
excess of fibrin in the blood (hyperinosis), the exaggeration of its coagul- 
ability (inopexia), the qualities of the serum, the excess of white globules, 
the abundance and abnormal viscosity of the hematoblasts, — and at last 
the simultaneous interference of several factors : such as a mechanical 
disturbance in the venous circulation, in the diminution in the bloody 
current, or in an alteration of this fluid. But none of these influences 
has, from the point of view of the production of thrombosis, the impor- 
tance that is offered by the condition of the venous endothelium. The 
diminution or even the arrest of the circulation through a vein do not give 
rise to thrombosis, if the endothelium, is perfect in its integrity. " Blood has 
been kept in a venous segment, between two ligatures, during several hours, 
even several days. On the contrary, as soon as the slightest alteration occurs 
on the endothelial surface (for instance, in striking the external face of 
the vein with a forceps), immediately clots are formed on the diseased 
spot, as it takes place round a foreign body introduced in the vessel " 
(Qu^nu). That which dominates in the formation of thrombosis, is the 
alteration of the venous endothelium. 

Bacteriological researches have shown this alteration in cases where the 
naked eye examination would not permit it. Some thrombosis reputed 
primitive have at last been recognized as secondary, of infectious nature, 
promoted by micro-organisms. Spontaneous thrombosis, so called, is most 
often but an attenuated form of phlebitis. " Between thrombosis called 
spontaneous and suppurative phlebitis, there is only a difference of degree ; 
the lesion is the same, the cause is identical." 

In its turn, the theory of Virchow had to give its place to the micro- 
bian. " This new doctrine considers some thrombosis (if not all) as of in- 
fectious nature ; it rests on severe observations and the presence, on the 
inside of thrombosed veins, of pathogenous micro-organisms ; it brings us 
back to the conception of primitive phlebitis, anterior to the clot ; it adds 
a pathogenous notion of great value, viz : that this phlebitis recognizes for 
cause the action, upon the living endothelium, of a microbian agent " 
(Qu6nu). 

Phlebitis is specially common on veins where bleeding is performed, in 
particular, in the jugular of horses, and the subcutaneous abdominal in 
bovihes. Umbilical phlebitis, frequent and dangerous in young subjects of 
all classes, shall be studied later on, in the chapter on Arthritis of Young 
Animals. 

There are several varieties of phlebitis. They are divided into super- 
ficial and deep, inier?ial and external, traumatic and spontaneous, ifi/ec- 



366 VETERINARY SURGICAL THERAPEUTICS. 

tious, constitutional and toxic. We will only consider them, as in Hunter's 
■ old division, as adhesive, suppurative and hemorrhagic. It is these which 
apply best to veterinary practice. 

Phlebitis and thrombosis being, in the very great majority of cases at 
least, the result of a microbian pullulation, of an infection whose ordinary 
agents are the staphylococci ; and again, adhesive, suppurative and 
hemorrhagic forms of phlebitis being related to various degrees of viru- 
lence of the causal condition, the treatment of the inflammation of veins 
must specially consist in the use of antiseptics. 

Phlebitis following operations performed upon veins shall be avoided by 
the observation of the rules of asepsy. One will not neglect that all 
venesection, to be harmless, involves the disinfection of the region and of 
the instrument that opens the vessel. By the antisepsy of wounds con- 
taining exposed veins, situated or involved in the traumatic center, the 
infectious inflammation must be guarded against. 

As soon as the diagnosis of adhesive pMebitis is justified, by the appear- 
ance of an indurated cord, surrounded by an oedematous swelling, the 
region must be immobilized and protected against all causes of irritation ; 
not only thus limiting the venous phlegmasy but also guarding against the 
breaking up of the clot and against embolics. (See Traumatic Thrombus 
and Embolics). In most of traumatic phlebitis, there is, at the wounded 
spot, a fistula which demands special care. The region wiU be clipped, and 
disinfected, the escape of the pus will be facilitated by enlarging the 
fistulous tract ; and this will be irrigated several times a day with an anti- 
septic solution (sublimate i p. 100, phenic or cresyled water 3 p. 100) ; and 
the wound will be covered with powder of iodoform or tannin, phenicated 
or iodoformed vaseline. Preparations of vaseline are preferable to lard 
ointment, which becomes rancid, irritates and makes the skin itchy. In 
phlebitis of the extremities, douches in spray, given several times a day, are 
advantageous. Later, when the acute phenomena have disappeared, 
blisters are useful as resolutives, as recommended by Renault, Bouley, Rey. 

When phlebitis is suppurative, so that the clot is infiltrated with pus, the 
inflamed vein is becoming fistulous, the swelling increases, abscesses are 
formed in various parts of its extent ; more than in adhesive phlebitis, the 
danger of portions of the clot becoming loose and purulent infection must 
be feared. There is escape of abundant pus, thin, of bad aspect, grayish 
or reddish and at times having a fetid odor. A probe introduced into 
the wound may penetrate far into the vein. It is proper to enlarge the 
fistula and make in the vein antiseptic injections (tincture of iodine, 
solution of sublimate, of phenic acid) with an India rubber tube adapted 
to the end of the syringe or with the bent canula (Nocard). This treat- 
ment, simple of execution, is recommended at the beginning, when sup- 



VARICES. 367 

puration is limited to a small distance in the vein ; it is insufficient when 
the phlebitis is old, when the vascular walls are infiltrated with pus, and 
the abscesses are developed in the perivenous structures. The vein must 
be drained in its suppurating portion. After making a counter opening 
on a level with the intravenous fistula, a fenestrated rubber tube is in- 
troduced in the tract to insure the escape of pus and allow the cleaning 
of the vein. We will return to this, in the article on suppurative phlebitis 
of the jugular. 

Another treatment consists in cutting down in its whole length the 
portion of the fistulous vein and treating the part exposed. Like Hoff- 
man, it is better, after exposing the vein in all its suppurating portions, to 
clean it by curetting ; to leave no diseased point in the neighborhood of 
the clot, clean the operated surface with a strong antiseptic solution and 
dress with iodoform. In the legs the curetting can be completed with 
antiseptic baths ; for the other regions, sprays are indicated. Between 
these the wound will be protected with compresses dipped in microbicide 
solution, or with antiseptic vaseline. 

Ligature and extirpation are means which to-day are little used. In 
some serious cases where free incision is dangerous, cauterizations with 
fine points or with needles, of the suppurating venous portion, has brought 
on recovery. 

Hemorrhagic phlebitis, complication of the adhesive and suppurative 
forms, due to the loosening, crushing, purulent destruction of the obliter- 
ating clot, is treated by plugging of the wound, suture of its borders or 
ligature of the vein. This last operation must be done antiseptically on a 
sound part of the vessel and beyond the induration. Layer by layer the 
tissues covering the vein are excised, the vessel is isolated and surrounded 
with an aseptic silk thread tied with a straight knot. The wound is 
irrigated with boiled water, is dried, dusted with iodoform, the edges 
brought together by two or three stitches, the whole covered with a col- 
lodion dressing. As for the fistula and the suppurating portion of the 
vessel, they demand the same care as indicated for adhesive phlebitis. 

IV. 

VARICES. 

Generally speaking, permanent dilatations of veins, varices or phlebec- 
tasis, are rare in all animal species. 

They occur most commonly on the veins of extremities, or those of the 
organs where the venous current has an ascending direction. In horses, 
they have been observed on the radial, saphena, axillary and testicular ; ,, 



368 VETERINARY SURGICAL THERAPEUTICS. 

in cattle, on the testicular ; in cows, on the mammary ; in pigs and dogs, 
on the scrotal veins. In a two-year-old filly, Debloc has observed a varice 
of the mammary vein as big as the head of a child. The extreme rarity 
of hemorrhoids in all animal species is explained by the direction of the 
pudic veins, and by the less pressure of the current of the blood, in these 
vessels, in animals than in man. 

The varicous dilatation of the saphena at the fold of the hock must 
not be mistaken for the synovial dropsies found in that region. Varices 
of the mammary veins, in bovines, may become voluminous, but do not 
give rise to serious complications. Deep venous ectasis are accompanied 
with dumbness, stiffness of the extremities and more or less pain. 

Varices are lesions of a slow, chronic development. In general they 
remain permanently, stationary or increasing little by little. Spontaneous 
recovery is possible by the formation of adhesive phlebitis, which obliter- 
ates the vessel. Left to themselves, they may become complicated with 
phlegmonous inflammation, ulceration and hemorrhage. In the case of 
Gillibert, the rupture of a varice of the axilliary vein was followed by 
death. 

The principal means of treatment of superficial varices are : pressure, 
cauterization, ligature, extirpation and coagulating injections. 

Radical cure of veins is seldom undertaken in horses. If it is to be 
attempted, a simple or double ligature should be applied above and below 
the dilatation, with all required antiseptic precautions. In the case related 
by Debloc, he made on the tumor two punctures with the fleam, closed 
with pin suture and applied blisters. Notwithstanding the result, in this 
case, ligature is better. 

If surgical interference is not resorted to, douches, cold baths or 
pressure with bandages are indicated. 



CHAPTER IX. 

LYMPHATICS. 

I. 

CONTUSIONS— WOUNDS— FISTULAS. 

The slightest cutaneous or mucous wounds involve the lymphatic net- 
-work, whose numerous canals drain the superficial layers of the dermis. 
Limited to the capillaries, these lesions are without importance : a small 
quantity of lymph mixes up with the blood, then the divided vessels 
cicatrize. They offer a certain gravity when large vessels are open. In 
animals, the superior face of the internal "face of the legs and round the 
articulations are places where these wounds are most met. They give 
flow to a serous liquid, which might be mistaken for synovia, when the 
traumatism is near an articulation. The weak viscosity of the lymph, its 
•whitish color, its coagulability, abundance of its white globules, the cessa- 
tion or increase in the flow whether pressure is applied in the direction of 
or against the current, all those establish the diagnosis. Often at the 
moment the wound is made, there may be seen a true jerk of fluid, which 
afterwards escapes in sheath, more or less abundant, increasing by exer- 
cise, which may make the flow return by jerks. 

A pinned suture is generally sufficient to arrest the hemorrhage. The 
compression of the leg, from its extremity to above the lesion, made with 
a flannel or a rubber roller, completed with an antiseptic dressing, slightly 
compressive, also gives good results ; by this way, the exit of the lymph 
contained in the open vessel is stimulated and the fluid mass carried during 
the following days is reduced, thus facilitating cicatrization. Spontaneous 
recovery is possible even in large lymphatic canals. Monro has seen, in a 
pig, the thoracic duct, artificially wounded, cicatrize rapidly. 

Having become fistulous, lymphatic wounds are tenacious. They are 
treated by cauterization with nitrate of silver or sublimate or with the red 
iron. Some practitioners prefer the injection of tincture of iodine. 
Ligature applied on the peripheric end will be used if other means have 
failed. It is sometimes difficult to apply it, and the operation is 
frequently followed by an infiltration of some size of the extremity. Abso- 
lute rest is indispensable, if quick recovery is expected. Infectious inflam— 

369 



370 VETERINARY SURGICAL THERAPEUTICS. 

mation is possible. If it occurs, the treatment of suppurative lymphangitis 
must be carried out. 

Subcutaneous ruptures of lymphatics give rise to the affection de- 
scribed under the name of traumatic effusion of serosity. 

Bruises of lymphatic glands are nofgenerally followed with special com- 
plications. Their treatment is that of bruises in general. 

Wounds of glands are rare. They may, however, be accidentally injured 
by wounding bodies and instruments of surgeons. The lyniphorragia, con- 
cealed by the hemorrhage, stops with it. In the majority of cases, these 
wounds demand only an antiseptic dressing and immobility. When the 
flow of lymph continues, canalicular tract is established which must be 
treated as the fistulas of lymphatic vessels. Extirpation of the glands is 
sometimes necessary. 

II. 

LYMPHANGITIS. 

Always secondary and produced by the entrance in the lymphatic vessels 
of phlogogenous infectious elements, lymphangitis or angioleucitis present 
numerous clinical varieties in all animal species. Generally those that are 
observed are of traumatic nature and have for starting point a tegumentary 
solution of continuity, — wound, prick, ulcer, abrasion. In cases where no 
apparent solution of continuity exists in the region, whose lymph is col- 
lected by the inflamed lymphatics, angioleucitis is the consequence of either 
an interstitial auto-inoculation (glanders, distemper, tuberculosis) or of a 
micro-trauma, rapidly wiped out, which still has lasted sufficiently to per- 
mit the passage of infectious elements. Numerous facts have shown that 
lymphangitis may appear after bruises without noticeable wound, re- 
peated frictions, or cutaneous impregnation by septic or f)utrid fluids. 
There are slow lymphangitis, " with incubation," which are manifested 
only a long time after cicatrization of the wound through which the agents 
of. infection have entered ; often then a shock or repeated frictions are the 
cause of this " inflammatory return." 

Acute or chronic, superficial or deep, lymphangitis are truncular, 
reticular or radicular, as they affect the lymphatic trunks, the cutaneous 
network or the roots of the white vessels in the various tissues. Favored 
by some constitutional or diathetic conditions, they are produced by very 
various pathogenous agents : there are as many kinds of lymphangitis as 
there are micro-organisms susceptible to irritate the white vessels. 

In inflamed canals, one often finds the staphylococcus albus or 
aureus, sometimes the streptococcus pyogenes, the bacillus coli or 
some leptotrix. Histology and bacteriolgy have permitted the distinction 



LYMPHANGITIS. 37I 

of Other forms of lymphangitis which we will study further on. Glanders, 
distemper, tuberculosis, carcinosis produce specific angioleucitis. 

The prognosis of those affections depends specially on their nature and 
the activity of the microbe that has caused it. When pathogeneous 
agents have but little virulence, the process has a tendency to subside, the 
morbid contents of the lymphatics is easily resorbed. Very active 
microgerms may, on the contrary, bring on suppuration or gangrene. The 
close relations between lymphatics and the serous system explain the com- 
plications of hygroma, synovitis, arthritis, peritonitis, which are some- 
times observed. 

Traumatic lymphangitis, the most interesting to the practitioner, is 
common in horses. We will give to it our special attention. 

/ — Traumatic Lymphangitis. 

This form may succeed all solutions of continuity of the skin. It is 
often seen in the withers, the shoulder, the neck, which are so com- 
monly the seat of traumas. A simple abrasion, the prick of a dirty lancet, 
are sufficient for its development. It ordinarily begins by a reticular 
angioleucitis, accompanied with great sensibility, bristling of the hair, oede- 
matous swelling of the skin ; and soon the trunks and the collecting glands 
are affected. 

There is a form of lymphangitis, specially frequent in the hind ex- 
tremities of horses, characterized principally by the suddenness of the 
invasion and the intensity of the first symptoms. A horse in perfect 
health in the evening is found the next morning dull, feverish, hanging his 
head, with a more or less marked and very painful swelling of a hind leg. 
The lameness is intense, the animal moves with difficulty and carries its leg 
in abduction. By examination, an oedematous swelling, painful in pro- 
portion to the severity of the attack, is detected on the internal face of the 
extremity. Appetite is partly or entirely gone. The following days, the 
swelling keeps on increasing until it assumes the form of a shapeless post. 
This sudden appearance of the affection and the great sensibility of the 
internal face of the hind leg are characteristic of the infectious inflamma- 
tion of the lymphatics ; most ordinarily, they justify the diagnosis of this so 
frequent variety of angioleucitis. Old writers, among them Solleysel and 
Garsault, attributed it to the bite of. the "shrew mouse." Lafosse refuted 
this error ; he thought it to be a variety of anthrax, against which he 
recommended scarification and repeated emollient lotions. In a paper 
addressed to the Societe Ccntrale (^1862), Mottet described the disease 
under the name of " Tarsopathy and Metaiarsopathy, or the diffused in- 
flammation of the tarsus and metatarsus." The discussion which followed 



372 VETERINARY SURGICAL THERAPEUTICS. 

the reading of the paper by Leblanc was most interesting and proved 
that the nature of the affection was yet a matter of much controversy. 
However, the theory of IMottet, who saw in it a tarsal inflammation, was not 
accepted. Several advanced the idea that those symptoms, so rapid and so 
accused, might be due to phlebitis of the saphena. Bouley claimed that the 
cord of the inner face of the thigh was due to lymphatics and not to venous 
blood vessels, that it was a lymphangitis and not a phlebitis. To-day, the 
fact is no longer discussed. Everyone recognizes in it an inflammation 
of the white blood vessels. This lymphangitis, so frequent on the hind 
legs of heavy draught horses, sometimes recurs at more or less remote 
periods. Some subjects seem to be predisposed to it. On examination 
of the leg, one finds a cutaneous solution of continuity, at times cracks, 
pricks, but quite frequently no door of entrance to the pathogenous 
agents can be found. The conclusion is that it is a lymphangitis without 
previous inoculation. If there is no visible solution of continuity, it is 
cicatrized or is so small that it escapes attention. Auto-inoculation 
(endogenous infection, latent microbism) is extremely rare. 

When lymphangitis follows an operation — nevrotomy for instance — the 
process is about the same. A few days after the operation, often after 
twenty-four or forty-eight hours, the swelling of the leg is well marked, the 
pain great, the resting of the foot on the ground suppressed, the appetite 
diminished or gone. The wound contains little or no pus, its edges, 
tumefied, are covered with a yellowish coating, diphteroid in appearance, 
somewhat adherent. After several serious affections of the leg, synovial 
inflammation principally, deep lymphangitis may occur, whose symptoms 
and prognosis are often most severe. 

Bacteriological researches made by us several years ago on suppur- 
ations of horses and dogs, allow us to affirm that, in these species, trau- 
matic lymphangitis are almost always the work of staphylococci and more 
particularly the staphylococcus pyogenes albus. 

The treatment must be specially preventive. Asepsy and antisepsy of 
the operation guard against thfs complication. Accidental traumatisms, 
specially wounds of the lower parts of the legs, should be carefully washed 
and protected by a dressing. By a correct antisepsy, the retention of the 
pus on suppurating surfaces and the infections of lymphatics will be pre- 
vented. 

As soon as lymphangitis exists, an active therapeutic must be started. 
Up to later days, bleeding was recommended ; many practitioners per- 
formed it on the jugular. Mottet preferred scarifications (eight or ten to 
the hock, fifteen or twenty to the cannon) two or three centimeters long, 
one or two deep ; he then soaked the leg in tepid water and thus obtained a 
bleeding of two or three liters. According to Serres, three or four fric- 



LYMPHANGITIS. 373 

tions of ammoniacal liniments were sufficient to obtain a rapid resolution. 
The same author had also obtained good results with embrocations of 
mercurial ointment, repeated eight or ten times. D'Arboval and Ray 
.advocated the use of blisters ; this, says Rey, " succeeds very well on the 
iiternal face of the cannon ; one application is generally enough." 
Several veterinarians resort to the charge of Lebas over the whole of the 
inflamed region ; others use populeum ointment, or again others prefer 
poultices. 

All these means have only a mediocre efficacy. Lymphangitis being 
the esultr of microbian injection, antisepsy must be the base of the treat- 
ment. One must act at the same time on the inoculated lesion, and the 
lymphatic inflammation, wounds, cracks, pricks, should be minutely dis- 
infected with a sublimate solution (i p. looo), cresyl or phenic aid 
(3 p. 100), and covered with a wadding dressing. Slight angioleucitis should 
1)6 treated often by col'd baths or douches, massage and exercise when the 
pain has subsided. General symptoms pass off first, but often the swell- 
ing remains for two or three weeks. 

When lymphangitis is severe, when it is a complication of a wound of 
operation or of one accidental on the extremities, warm antiseptic baths are 
indicated. They will be administered two or three times a day and last half 
an hour each. It is advantageous to cover the inflamed surface with tepid 
phenic or sublimated compresses. The absorbed fluid progresses in 
lymphatics, where they bring their direct disinfecting action. Damp 
moisture favors the resorption of exudates ; perhaps in some cases they 
act in reducing the virulence of infectious elements. In other regions, 
one may advantageously use antiseptic washing or spraying and protect 
the wound with a dressing. To reach with more certainty the pathogen- 
ous elements, some authors have advised injection of phenic water at 

2 p. 100, here and there along the course of the inflamed lymphatics. 
Repeated coatings of the leg with a solution of perchloride of iron at 

3 p. 100, or diluted tincture of iodine, are worth trying with antiseptic 
baths. With deep lymphangitis, antiseptic balneation is also a good 
mode of treatment. By it, the inflammation and the pain rapidly disap- 
pear, and complications are avoided. 

Instead of ending by resolution, lymphangitis may pass to suppuration : 
pus forms in the lymphatic vessels, in the perilymphatic cellular tissue and 
sometimes in the thickness of the dermis. In some parts of the lymphatic 
cord, , rounded fluctuating tumors are formed. And from them, either 
after ulceration or if open by puncture, escapes a thick, whitish pus/ 

^ In the case related by W. C. Siegmund, the original cause of the lymphangitis 
remained unknown. Several superficial abscesses had formed on the coronet, inside 
cf the hock, alongside the thigh, some 40 in number. Tested with mallein, negative 



374 VETERINARY SURGICAL THERAPEUTICS. 

Antiseptic cleanings insure the cicatrization : it is rare for lymphorrhag3r 
to last ; when it occurs on the extremities, it is always the most dependent 
abscess which becomes fistulous. Diffuse suppuration and undermining; 
demand counter-openings and drains. It is specially with deep lymphan- 
gitis that sub-aponeurotic purulent collections and extensive gatherings 
are to be looked for. Puncture of the fluctuating points is not always 
sufficient ; the swelling must be carefully watched ; if the presence of a 
purulent infiltration is suspected, explorating punctures must be made. 

Septic or gangrenous forms of lymphangitis are rare. However, they 
have been observed for many years (Vatel and Crepin) . A first important 
indication consists in making, in the swelling, punctures with the red iron. 
Frequently repeated antiseptic baths or sprays are to follow. In serious 
cases (diffused suppuration, septic complications, gangrene) tonics, alcohol, 
and antiseptics should be given internally. 

Chronic lymphangitis develops in two ways : at times it appears at the 
onset and by degrees reaches its definite characters ; or again, it follows 
the acute form. In this last case, the swelling of the upper part of the 
leg subsides, it remains more or less marked at the coronet, fetlock or 
cannon, and there the induration gradually organizes itself. The oedema 
spreads in the cellular tissue, irritates it, and also the deep surface of the 
skin, the exuded fluid becomes fribrinous, the subcutaneous tissues 
become indurated, the skin is thickened and sclerotic. 

Against these cold swellings of the lower regions of the extremities, 
therapeutics is rather poor. Blistering has given some success to Leblanc 
and Mottet, but fails in most cases. The same can be said of the various 
liniments and tonics recommended. According to Siegmund andZundel, 
laurel and camphorated ointments, mixed with extract of belladonna, con- 
stitute a true specific to remove the oedematous swelling — an opinion which 
has not been approved by experimentation. Cauterization has been 
frequently used ; if it has seemed successful with Lardit, Leblanc and 
many others have seen it fail in their hands. Many cases might be men- 
tioned where firing and blistering have aggravated the swelling. Seton at 
the thigh, on the gluteal region, and scarifications have had and have yet 
many advocates. 

Is it proper to follow an internal treatment? Jacob, already in 1855, 
advised iodine or iodide of potassium, after having obtained some results 
ixoAi them. Here, as in numerous affections with sclerotic tendency^ 
iodide may be useful, specially in recent cases. Yet its action must not be 
too much depended upon. 

Sometimes chronic lymphangitis resists all treatments ; the coronet, fet- 

Tesults were obtained. At the post-mortem a large abscess was found in the thick- 
ness of the ischio tibial muscles. — American Veterinary Review, vol. 18, page 290. 



LYMPHANGITIS. 375 

lock and cannon swell more and more, and whether or not acute attacks 
reappear, arrives the process comes to the elephantiasic fibroma. Moderate 
exercise, thorough cleanliness of the extremity, hot water, massage, 
moderate and intermittent compression with flannel or rubber bandages ; 
such are the best indications to follow. Elastic pressure, as we have 
said, demands some attention. A pad of oakum or wadding should always 
be laid against the skin before the not too tight roller is applied and not 
allowed to remain more than ten or twelve hours. Excessiveor continued 
pressure promotes sloughing of the skin and of the tissues underneath. If 
abscesses form, they should be opened at once. Chaps and cracks of the 
skin should be treated by antiseptics and rest. By moderate pressure 
also the oedemas occurring under the influence of standing in the stable or 
-during rest at night will be prevented. 

//. — Specific Lymphangitis. 

Epizootic lymphangitis, also called farcy of Africa, farcy of Naples, 
farcinosus lymphangitis, is a specific, contagious affection, produced by the 
£ryptococc2is farcinosiis of Rivolta. It is proper to solipeds. Very com- 
mon in Africa and at the Guadaloupe, it is rare in France. 

In the infected localities, wounds of all kinds may be followed by it. 
It is observed principally on the legs, the withers and the lateral parts of 
the trunk. Its incubation varies from a few days to several months. The 
•borders of the wound become indurated and very painful ; in its surround- 
ings appear pimples (buttons) and then cords progressing along in the 
•direction of the lymphatic current ; the collecting ganglion later on forms 
a mamillated hard tumor. After a certain time, cords, buttons and 
.glandular tumors become soft, ulcerate and allow the escape of a laud- 
-able, creamy pus. These wounds, " cul de poule like," cicatrize very slowly ; 
many become fistulous. The invaded region is always much engorged ; 
the legs assume shapeless sizes. The observations of Blaise, Couzin, 
Nocard, have shown that this affection, localized to the pituitary mem- 
brane, may give rise to ulcerations resembling those of glanders. 

At times difficult, the diagnosis can be established by microscopic 
examination, the specific microbes being in abundance in the pus and 
in the superficial layer of the wounds. Mallein gives also good indications. 

The disease existing almost always upon a more or less large number of 
animals, the most elementary prudence imposes the sequestration of the 
patients. A ministerial order {YtbrxiZixy ii, 1887) prescribes the measures 
to take with horses and mules of the army. In civil practice, besides 
isolation, disinfection is recommended. During rainy weather, wounds 
of all kinds should be treated antiseptically and protected with a dres- 



3/6 VETERINARY SURGICAL THERAPEUTICS. 

sing. These measures are generally sufficient to arrest the progress of the 
disease. 

The curative treatment is composed principally of external applications. 
After Tixer and Delamotte, several veterinarians have tried without suc- 
cess internal treatment with arsenious acid, kermes, iodide ofpotassimn, 
mercurial compounds, nux vomica, tincture of iodine, hyposulphite of soda. 
To this day, however, we do not know of therapeutic agents, which, given 
internally, arrest the pullulation of the pathogenous element. To give 
the patient a nourishing food is the important indication ; and tonics 
and stimulants are useful. 

Every author recommends to open the buttons with the red iron ; to 
render the cauterization deeper, some dust the tract made by the iroa 
with sulphur powder and bum it over. Decroix added to these points one 
line of deep cauterization applied transversely in front of the lymphatic 
swelling, which'never went beyond this barrier. Nocard has advised a free- 
incision in the whole length of the cord and the destruction of its internal 
wall by curetting or actual cauterization. Others have recommended the 
extirpation of the cord with the thermo-cautery, taking with it some of 
the healthy tissues. Peuch has seen this done with complete success. 
Jacoulet has warmly recommended the free extirpation of the cord and of 
its glands. The operation is simple when the cord is small and well de- 
fined ; it becomes very difficult when the swelling is large, extending from 
one end of the leg to the other, specially when the cord, the vessels and 
nerves are involved in the same fibrous thickening. On this account, 
extirpation remains limited to few special cases. Points firing with 
free incision of the cord and curetting are specially applicable to extensive 
lesions. To stimulate the cicatrization of wounds thus made, several 
topics have been recommended ; blisters, tents soaked in camphorated 
and phenicated alcohol (Wiarl), burnt alum, sulphate of copper, Rabel 
solution, nitrate of silver, tincture of iodine, diluted nitric acid. Anti- 
septic liquids (injections, baths, repeated sprays, with solution of cresyl 
or phenic acid 3-4 p. 100, sublimate i. p. 1000) and dressing with iodo- 
form, deserve preference over the others. 

Actively treated, the affection ends ordinarily by recovery after a lapse 
of time varying between several weeks and two months. In some cases, 
cicatrization of the wounds has required five, six and seven months. 

Besides the traumatic lymphangitis and the pseudo farcinous form, 
other lymphatic inflammations are met with in animals which are due to 
.special parasites or to specific processes. 

The /arcy of oxen, very rare in France, common at the Guadaloupe, has 
for principal manifestation a suppurative inflammation of the lymphatic 
vessels and glands. The disease may invade the visceras (spleen, liver» 



ADENITIS. 377 

lungs), bring on excessive emaciation and end in death. It is not glanders, 
nor tuberculosis, but a special microbian affection. In the post- mortem 
pieces sent to Nocard by Couzin, he found a " fine and long bacillus, 
assuming the form of little snakes entangled together ; the central part 
resembling an opaque nucleus, from which radiated towards the periphery 
delicate ramified threads; it gives the idea of the head of a cauliflower, a 
bundle of thorns, or, better, a seed of burdock." It is inoculable to the 
guinea-pig, cow and sheep. Horse, donkey, dog, rabbit, are refractory. 
On these animals it only gives rise to a small abscess at the point of 
inoculation. 

Puncture of the abscess, made at an early date, free incision of the 
cord, cauterization, curetting of their internal surface, constitute the local 
treatment. Good food, tonics, stimulants, are also indicated. Recovery 
occurs generally ; but one must count with the inflammation of the sur- 
rounding lymphatic vessels and glands, and many subjects die in marasm. 

Tuberculous lymphangitis have been studied but little in animals. 
Godbille records an interesting observation of it. A steer in good con- 
dition had on "the external face of the right anterior leg, a linear series of 
bosselated, irregular tumors, of the size of the fist and moving under the 
skin." The lower one was ulcerated, others showed fluctuation. On post- 
mortem, all the internal organs were healthy, except some mesenteric 
glands, infiltrated with granulations. Recognized early in some species, 
tubercular lymphangitis may be treated either by incision and curetting, 
or by excision ; in some cases, the extirpation of the collecting ganglion 
completes the interference. (See Tuberculosis^ C^/zr^ris-z/i- lymphangitis, 
common in dogs, are most always present in cases of serious epithelial 
tumors. Very frequent in the mammce of sluts, they constitute thick 
subcutaneous cords, nodular, and extending to the glands. Their total 
extirpation, when the disease is comparatively recent and the patient 
strong, is the only proper treatment. Old age, anemia, generalization of 
the neoplasms, counter-indicate interference. (See Tumors.) 

Lymphangitis of distemper are ordinarily not serious. In general, ab- 
scesses punctured and freely opened recover by the simplest antiseptic 
cares and the lymphatic induration diminishes little by little. 



III. 

ADENITIS. 

True filters placed on the course of lymphatics, the glands arrest in- 
fectious germs carried by the lymph. Their puUulation, the increasing 
irritation that they produce on the glandular stricture, promote adenitis. 



378 VETERINARY SURGICAL THERAPEUTICS. 

For a long time, it was believed that adenitis were primitive, but it is ad- 
mitted to-day that the glandular inflammation results, in all cases, from 
an inoculation produced either directly through a wound of the gland, or 
indirectly by a lesion some distance from it, existing on the course of the 
afferent blood-vessels. Glands seem even more sensitive than the vessels ; 
in clinics, lymphangitis without adenitis are exceptional ; adenitis with- 
out lymphangitis are not. 

If the most varied micro-organisms circulating in lymph may irritate the 
glandular sifter, acute adenitis, like lymphangitis, are ordinarily produced 
in animals by staphylococci and sometimes by streptococcus. The re- 
searches of Schwarznecker and ours show that ordinary adenitis of horses 
are generally due to the stapjiylococcus albus. The clinical varieties of 
adenitis (tumefaction, induration, suppuration) are related to the varying 
virulence of this staphylococcus. It is the streptococcus of Schiitz which 
causes the suppurating adenitis of distemper. In bovines and other 
animals, acute adenitis of various nature have also been observed, most of 
them due to ordinary pyogenous microbes. 

Ordinarily produced by inoculation from a wound at some distance from 
it, adenitis demands first the use of antiseptics on the wound and the 
afferent lymphatic blood-vessels, completed by a wadded dressing. The 
primitive lesion, cutaneous or mucous, should be treated by antiseptic 
irrigations, pulverizations or baths frequently repeated. Hot balneation 
is to be preferred. Upon the inflamed gland, tincture of iodine may 
be applied, a blister, or better, when possible, tepid antiseptic com- 
presses. Intra-glandular injections of phenicated water 3 p. loo 
(Hueter) have not been tried in animals. General and local bleeding are 
abandoned. 

The march of the inflammation depends on the degree of virulence of 
the germs. A well made antisepsy will get the best of a microbe with 
weak virulence ; little by little, the swelling diminishes, the pain subsides, 
resolution takes place. Other germs, more active, produce pus. As soon as 
it is formed, it must be allowed to escape and then antiseptic washes used. 
The opening of some glandular centers- — subparotid or retro-pharyngeal 
abscesses, those of the axilla or of the groin — demands some attention ; in 
these regions, the bistouri must be handled with prudence, if large vessels 
and nerves are to be avoided. The free incision of the maxillary glands is 
without danger, and the puncture occupying dependent location, pus always 
runs freely. At times, specially under the parotid, the pus has reached 
the periadenic cellular tissue, there are great underminings and the 
glandular origin of the abscess is difficult to locate. In such cases the 
incision must be made large or a counter opening established ; drainage is 
also obligatory. Ordinarily the wound closes rapidly. If healing goes oa 



TUMORS. 379 

too slow, the wall may be curetted, dressed with iodoform or injected 
with tincture of iodine or iodoform ether. 

Sometimes chroiiic adenitis follows the acute form ; at times it occurs 
at once, either under the influence of specific diseases (glanders, tubercu- 
losis, carcinosis), or as consequence of a sub-acute or chronic inflamma- 
tion. The glands of a same group become hypertrophied and remain 
independent (simple adenitis), or they gather and unite into a single 
mass (adenitis and periadenitis). 

In general, chronic adenitis are little painful. They have a great ten- 
dency to last, and when the affection which has promoted them has dis- 
appeared, it takes a long time for them to disappear, ' Slow resolution is 
not their only termination ; sclerosis is frequent ; an acute return may bring 
Suppuration. 

The treatment must, first of all, look after the causal lesion. In pro- 
portion as the wounds of the legs cicatrize, the glands of the axilla or of 
the groin resolve. Similarly, the maxillary gland diminishes in size when 
the purulent collection of the sinuses goes toward recovery. Local treat- 
ment has little efficacy. Blisters have been recommended, napolitan 
ointment, tincture of iodine, iodurated pomatum. If these are not suc- 
cessful, superficial or deep cauterization deserves trial. Extirpation of 
the indurated glands has been little performed in animals. We only use 
it to establish the diagnosis in specific adenitis. In all cases, ioduie of 
potassium internally will help. 

Suppuration of chronic adenitis is treated like that of acute : incision 
and antisepsy.' 

IV. 

TUMORS. 

Primitive tumors of glands are extremely rare. Almost always secondary, 
they generally accompany epithelioma and carcinoma, sometimes sarcoma 
or enchondroma. In cancer, the glands, run through by the lymph of the 
affected ground, are always suspicious. Generalization begins at the 
nearest gland, that which collects the lymphatics of the primitive 
focus ; hence it spreads little by little ; and frequently true neoplastic 

^ Dr.'F. S. Allen'has recorded two cases of chronic adenitis successfully cured by 
the removal of the enlarged gland. In one instance, microscopic examination 
proved it to be a small spindle celled sarcoma. The whole tumor weighed eight 
ounces. In the other, the growth weighed only four ounces. Microscopic e.xamin- 
ation showed it to have been originally lobulated, with hollows at intervals and at 
points containing small abscesses. It proved to be a lymphatic gland in a hypertro- 
phical condition undergoing an irregular process of regeneration. — American Vet. 
Jieview, vol. 8, pages 183 and 185. 



380 VETERINARY SURGICAL THERAPEUTICS. 

chains are observed. Staphylococci with attenuated virulence may pro- 
mote glandular indurations resembling tumors ; but the fact is rare ; it is 
observed, however, with the submaxillary glandsof horses ; fistulous indura- 
tions can also be met in them, which suggests the presence of ulcerated 
tumors. 

Entire ablation is the only proper treatment. Easy for primitive tumor 
and superficial glands, it may be impracticable for deep ones. The con- 
dition of success is to operate early and stop only when healthy tissues are 
reached. All surgical interference is contra-indicated when the disease 
has gone beyond the glands that may be reached by the bistoury, specially 
Avhen there are evidences of generalization. 

V. 

LYMPHANGIECTASIS. 

Those are glandular, truncular, or reticular. In man, spontaneous 
lymphangiectasis have been described, whose cause remains to be deter- 
mined, and symptomatic lymphangiectasis, related to the inflammation or 
compression of the white vessels. In diseases of the heart or of its en- 
velopes, there exists sometimes a general dilatation of the whole lymphatic 
system. At the autopsy of a horse suffering with valvular endocarditis 
of both left openings, with extensive hypertrophy of the right heart, 
Nocard found " such dilatation of the lymphatics that the thoracic dtict 
had reached the size of the arm, and that upon the colic mesentery 
the chilliferous vessels, filled with transparent lymph, measured one and 
one-half to two centimeters in diameter." Such lesions are of no in- 
terest in a surgical point of view, and lymphatic varices are extremely rare 
in animals. Nocard has related two cases of them. In one, it was a soft 
tumor, " puffy and fluctuating, of the sheath ; repeated capillary punctures 
gave at each time a small quantity of limpid transparent fluid ; a serous, 
multilocular cyst was suspected. Post-mortem revealed that it was a 
gathering of large lymphatic vessels rolled upon themselves, entangled 
intimately, whose walls, thick and very adherent at their points of contact, 
had preserved in any other part of their length their characteristic thin 
aspect and their transparency ; numerous valvular contractions could leave 
no doubt as to the nature of the tumor. 

" In the other case, the varices were on the lymphatics, satellites of the 
saphena vein, not far from the groin, where they formed little soft tumors, 
fluctuating, extremely irregular, enveloping the vein all round, upon a 
length of about twelve centimeters, to such an extent that it was impossi- 
ble to bleed at that vein ; and that it could not be opened except at the 
lower part of the shank, below the inferior border of the short adductor. 



LYMPHANGIECTASIS. 38 1 

" In both cases, the dilatations were surrounded with a thick layer of 
connective tissue, gorged with serosity and on the road to induration." 

For man, elastic stockings, knee caps or cuffs form the whole treat- 
ment. Analogous means might be tried in animals. Extirpation gives no 
good results ; all surgical interference must be avoided. Sometimes 
superficial dilatations ulcerate ; in these cases the therapeutics is the same 
as that of lymphatic fistulas. 



CHAPTER X. 

NERVES. 

I. 

TRAUMATIC LESIONS. 

Traumatic lesions of nerves are accompanied with complex troubles, 
divided into immediate and consecutive. The former are known for 
many years ; the others have brought about numerous discussions, and, 
actually, the pathogeny of those is not yet entirely elucidated. 

Whatever may be the nature of the wounding body, the phenomena 
that take place in the ends of the bruised or divided nerves, are about the 
same in all cases. For centuries, the Galenic assertion, " any nerve cut 
cannot grow nor unite," has been admitted. But facts are related, showing 
that the sensibility and mobility sometimes reappear in regions where they 
were temporarily abolished by division, with or without loss of substance, 
of the trunk which innerve them. It appeared, then, that divided 
nerves could cicatrize and recover their functions temporarily absent. In 
old observations, the return of innervation, to insensibilized or paralyzed 
regions after a traumatic lesion, had been observed only after quite a long 
time. This was explained by the admission of nervous regenerations ; 
but no proofs were given to sustain this admission. In 1867, Richet, 
watching a case of section of the median nerve, observed that sensibility 
remained m the tissue animated by the divided nerve. A plausible explana- 
tion of the fact was looked for, when Arloing and Tripier gave it the true 
interpretation. 

Veterinarians have for a long time noticed that plantar neurotomy 
made above the fetlock, on one side only, did not result in the complete 
anesthesia of the corresponding half of the foot. Moorcroft, who had 
made this remark, explained it by iht/uiictiotial solidarity of Xht flan tar 
nerves, by a kind of nervous assistance. Arloing and Tripier have shown 
that after the section of a nervous branch, the sensibility remained 
attenuated in the region animated by this branch, thanks to the recurrent 
fibres that each nerve mutually exchanges with other nerves. At the point 
of division, there are numerous anastomosis ; nervous threads belonging 
to a given branch, return to one or more branches close by, where they 
aningle, to go and terminate further on. After the section of a nerve, 
382 



TRAUMATIC LESIONS. 58^ 

■while the direct fibres degenerate at the peripherical end, the recurrent 
fibres remain intact and keep up a certain sensibility in a region which was 
supposed entirely anesthetized. The theory of preserved sensibility took 
the place temporarily of that of the returned sensibility and for a time nervous 
regeneration was considered as the appanage of youth. It is scarcely 
ten years since a most distinguished surgeon contested again the regenera- 
tion of nerves, and affirmed that, even in making the suture of both ends, 
the nervous current was unable to pass through the cicatrix. He said, if 
sensibility is not entirely abolished, the fact is due to collateral roads, and 
as motor nerves have none, motility is, in general, extinct without possibility 
of return, by their division. 

Some time later nervous regeneration was definitely established by 
numerous Observations and experimental researches. 

How does it take place? 

When a nerve has been divided, the peripheric end loses its properties. 
In each interannular segment, at the same time that tlie nucleus lying 
against the sheath of Schwann swells and proliferates, the myeline breaks it 
on its external face, on a level with each incision of Lantermann, and is thus 
divided into balls. The cylindraxis, affected by the nuclear proliferation, is 
in its turn indented and thousands of times cut alongside the degenera- 
ting fibres ; soon it disappears, as well as the myeline, which is resorbed. 
The sheath of Schwann is then filled with protoplasm and nuclei ; later, 
these last elements atrophy, the protoplasm in its turn is resorbed and of 
the nervous thread there remains but empty sheaths of Schwann, plicated, 
lost in the middle of a fibro-fatty tissue. This change is general and 
absolute — with exception for the recurrent fibres — and if regeneration 
takes place, the cylindraxis must be rebuilt entirely. 

Curious modifications occur in the central end, which do not extend 
beyond the first annular contraction. In this short portion, the nuclei 
proliferate, the myeline breaks up. There, a round or ovoid swelling 
(central bulb of the neuroma of regeneration) is formed, grayish-white in 
color, adherent to the surrounding tissues, encysted in a cicatricial mass 
and united to the peripheric end by an intermediate tractus (cicatricial 
segment) which serves as conductor to the regeneration. The cylindraxis, 
instead of undergoing regressive changes, as in the peripheric end, be- 
come the seat of a special constituting activity ; except those belonging 
to recurrent fibres on the road to destruction, these cylindraxis granulate 
at the point of the first contraction, from which start myeline tubes . 
which ramify in the neuroma of generation. A single cylinder may give 
twenty, thirty, forty of these tubes, which may be very irregularly arranged, , 
entangled, running through a thick conjunctive mass. 

When the ends of the divided nerve are united or close to each other„ , 



384 VETERINARY SURGICAL THERAPEUTICS. 

the young fibres run through the cicatricial bridge thrown between them, 
reach the peripheric segment, penetrate into the sheath of Schwann or 
mingle together, and many of them instill together as far as the limits of the 
degenerated nerve, which is thus reconstituted. If these ends are separated 
by a cicatricial structure of a certain length, regeneration still takes place, 
providing, however, that the distance does not exceed 6 or 7 centimeters. 
It is so much more easy and complete that the interfragmentary cicatrix 
is more recent and shorter. It can not reach the periphery except by a 
conductor, and of course it must be admitted that many new-formed 
fibres are lost, degenerate, disappear ; others stop in their way ; those that 
reach the periphery — the useful fibres — are but a small portion of the ele- 
ments born from the central end. At any rate, regeneration is always 
incomplete ; the new nerve is far from having inherited, in the same degree 
as the old one, properties of sensitive and motive branches. 

Some surgeons have recently mentioned cases in which sensibility re- 
turned in some regions, immediately after bringing in contact the ends of 
the divided nerve distributed in those regions (Tillaux, Nicaise, Polaillon, 
Segond, Berger). This fact has been explained by recin-retice, assista^iccy 
ar7'est of inhibition or dynamogeny ; but it is difficult to give of it a 
satisfactory interpretation, with the actual data of physiology.' 

It has been demonstrated that divided cylindraxis never unite again to 
others ; there is always between them a fibrous cicatricial tissue, even in 
cases where immediate reunion has been obtained ; the preparations of 
Quenu prove it abundantly. The suture, performed early, cannot 
prevent the degeneration of the peripheric end. A fortiori, when the 
division is old, the most perfect suture will not permit the immediate 
passage of the nervous current ; for this, the peripheric end, " true 
cadaver," must be reanimated by regenerating from the centre to the 
periphery. Like anatomical repair, the functional remains very imperfect. 

The duration of the regeneration varies according to age, the height to 
which the nerve is divided, and whether there has been simple division or 
excision. It varies generally between five and six months. 

These data are sufficient to understand, better than with all proposed 
explanations, why the sensibility remains indefinitely reduced in the 
regions placed under the influence of nervous branches which have been 
divided or resected and why some lameness does not return, after 
neurotomy, notwithstanding the regeneration of the divided nerve. 

If the removal of the nervous influence does not seem to exercise a visible 
immediate action upon the intimate phenomena of nutrition, it may- 
bring on lesions with rapid or slow development, inflammatory or gangren- 

* Berger, Laborde, Lifort, Btdletiu de VAcadhnie de Medecine, Paris, 1893, PP- -93» 
313. 355. 450- 



TRAUMATIC LESIONS. 385 

ous in nature, hypertrophical or atrophica!, specially when other causes 
occur ulteriorly, some of which are known — traumatisms, infections — and 
others remain unknown. In the field of distribution of a divided 
nerve, no organ or tissue is surely exempt from it. They have been 
observed, specially in the skin, cellular tissues, tendons, bones and 
articulations. Their mode of production is only imperfectly known, but 
in animals, no more than in man, subsequent traumatisms do not seem 
necessary to their production. On this point, clinical observation and ex- 
perimentation agree. If, says Lancereaux, the production of lesions " is 
assisted by a traumatism or any irritation of the tissues, it must be acknow- 
ledged that this circumstance is not absolutely necessary and that some 
times gangrene occurs entirely without any special occasional cause." 
Quite recently, in a horse upon which, two years ago, we had divided the 
external plantar nerve above the fetlock, we have seen appear, without 
any traumatism, serious lesions which condemned him to be destroyed. 
Brown-S^quard and other observers, who have studied the effects of the 
section of the sciatic nerve, have not always seen the leg remaining indeinne, 
as some pretend ; in several animals, they have seen numerous trophical 
troubles, specially gangrene of the extremity and sloughing of the 
phalanges. 

The co7nptessio7i of nerves has causes whose action is either sudden or 
slow. One understands that the evolution of the troubles will differ 
Avhether the compression is produced severely at once in the middle of a 
traumatic center or realized gradually by a neoplasm developing ia 
proximity of a nervous cord. On animals kept in decubital position for a 
long time, specially when a leg is secured in crossed position, a more or 
less complete impotency of the displaced leg is sometimes observed, due 
as it is to the compression of the brachial plexus between the arm and the 
trunk. After some dystokias, when powerful tractions have been made to 
remove a foetus of abnormal size, out of proportion with the dimensions 
of the canal through which it has to pass, one may frequently observe, in the 
cow especially, a lameness due to compression of the obturator nerve (see 
Paralysis). Accidents of similar order brought on by the compression 
of the gluteal nerve or of the great femoro-poplitial, have been observed. 

The application of cords and hooks may produce, in the foetus, various 
paralysis yet little studied. Traumatic lesions, inflammatory exudates, 
large cicatrices, tumors, exostosis are as many causes of compression of 
nerves. At the post-mortem of a horse, affected with incurable lameness, 
Rigot found, at the point of insertion of the tendon common to the great 
dorsal and the long adductor of the arm, an irregular exostosis, which, 
had injured some of the nerves of the brachial plexus ; " the neurilemna 
and pujp of these nerves was of a dark-wine color." When the com-* 



386 VETERINARY SURGICAL THERAPEUTICS. 

pression is great or continued for a long time, the lesions consist irt 
degeneration of the nervous cord and the paralysis of the region where it 
is distributed. 

Paralysis from casting will be avoided by not keeping the animal too 
long down, specially when the anterior leg of the side on which he lies is 
fixed in crossed position. In difficult accouchements, the foetus must be 
displaced and put in good position to facilitate its exit and avoid all 
nervous lesion of the pelvis. 

The treatment of compressions of traumatic nature and of paralysis 
resulting from it, is that of nervous contusions : rest and irritating frictions 
on the affected muscles. If these atrophy, blisters, cauterization, exercise 
are the most recommended agents. 

Some paralysis due to the compression of a nerve by a bony callus demand 
that it should be isolated from it. After the incision of the skin and tissues 
underneath, the nerve is liberated by the aid of the gouge and mallet, 
acting with a great deal of care. The nerve disengaged, the muscles re- 
cuperate their functions and return by degrees to their physiological condi- 
tion. The ablation of a large cicatrix or of a tumor may also remove 
troubles produced by compression of the nerves in its neighborhood. 

Contusions of neivcs result from external (blows, knocks, falls) or from 
internal causes (luxations, fractures). They are observed generally on 
nerves that are little protected. The facial, on account of its superficial 
situation, is the most frequently affected. In the legs, nervous trunks, 
situated rather deep in the greatest part of their course, are rarely injured 
by traumatisms. 

The lesions made vary according to the severity of the cause ; at times 
there is only a slight bloody extravasation between the tubes and rupture 
of some of them ; at others the bloody infiltration extends in the nervous 
cord, far from the contused point ; in serious cases, there is crushing of 
the nerve, rupture of its fibres, distension of the sheath by a reddish 
pulp. Whatever may be the degree and extent of these lesions, the 
neurilemma is intact or very little altered. The divided nervous tubes 
undergo the wallerian degeneration in their peripherical end, and when the 
nerve is entirely crushed, the recurrent fibres alone escape destruction. 
These disorders are characterized by sharp pain at the injured spot, 
which sometimes extends alongside the nervous trunk, and by a more or 
less complete paralysis of the sensibility and motion. 

Rest is the first indication common to all the cases. Besides, the 
resorption of the exudate should be stimulated so as to relieve the nervous 
element and prevent neuritis. Antiphlogistics, massage, then stimulating 
and blistering applications are ordinarily used. The administration of 
iodide of potassium internally is advantageous. The paralysis of all the 



TRAUMATIC LESIONS. 387 

•muscular groups where the contused nerve is distributed sometimes 
remains. 

After being considered for a long time as absolutely harmless, ligature 
of nerves is accused of serious accidents. Now, it is known that it can- 
not give rise to tetanus, but it produces acute pains, neuritis, paralysis ; on 
that account isolation of nerves during operation is essential. If an artery 
is to be ligated, the surrounding nerves must be respected. The close 
relations of the pneumo-gastric, sympathetic and recurrent with the carotid 
are known : it is useless to insist on the danger of constriction of these 
important branches. In the rare amputations that we have made, the 
nerves were always isolated and divided a little higher than the other tissues. 

Ligature of nervous branches gives rise to active reactions. If it has 
been done accidentally, the ligature must be cut immediately and the 
nerve carefully isolated from the tissues which are to be ligated. 

Though nerves enjoy a great elasticity, they are exposed to stretching, 
tearing and pitUing. Luxations, fractures with displacement, callus, 
tumors of large size, violent mechanical or traumatic actions may produce 
in nerves lesions varying from the simple distension to complete tearing. 
In the celebrated stallion Physician, affected with a fracture of the fore- 
arm, the cubito-plantar and cubito-cutaneous nerves were found lacerated 
by the fragments of bones and inflammed in two-thirds of the extent of 
the forearm. Under the influence of mechanical or traumatic influences 
of equal violence, arteries and veins give away before nervous cords 
do. In these, the nervous tubes break up first, the neurilemma 
stretches like the external coat of arteries. The pulling of sensitive 
nerves gives rise to pain, to which succeeds anesthesia in the field of dis- 
tribution of the involved nerve. With motor nerves, the same cause brings 
on paralysis. The artificial pulling of nerves has been tried in man, to 
overcome some painful affection. Trials of this kind, made on horses, 
have given results inferior to those obtained by neurotomy. 

Ordinarily in simple stretching, after having attended to the cause 
(reduction of luxations, of fractures, removal of a tumor, partial resection, 
of a callus) sensibility and motricity reappear. Revulsives may usefully 
overcome the consecutive disturbances. Complete pulling generally goes 
with such serious lesions that the killing of the patient imposes itself. 
Amputation of the leg or suture of the nerve are the means to use in small 
species. 

Nerves may be the seat of pricks, cuts, contused or gunshot woiinds. 
We are lacking clinical documents upon simple pricks of nerves in 
animals. Notwithstanding the small size of the wounding body, a few fibers 
are always divided : a " bloody sub-neurilematic or interfascicular suffu- 
sion " takes place, producing only slight troubles. 



388 VETERINARY SURGICAL THERAPEUTICS. 

Complete accidental sections are met with wounds made on the course 
of nerves. In contused or torn wounds, the nerve is flattened or 
stretched, and as its resistance is greater than that of arteries and veins, 
it generally gives away only after them. Projectiles may perforate, cut or 
even tear off a piece of a nerve. 

Nerves are retractile like arteries ; after their section, both ends separate ; 
to favor the repair of the organ, it is indicated to apply suture of the nerve. 
The atrophy of the peripherical end is unavoidable ; even with the most 
perfect suture, a cicatricial septum is always formed. It is not doubtful 
that sensibility and mobility may last or suddenly reappear a few days 
even a few hours after suture ; but, as we have said, this must be explained 
otherwise than by the immediate reunion of the cylindraxis. However, 
clinical and experimental results justify the suture of nerves, and the opera- 
tion must always be done early. Although it has been performed but 
little in our animals, there are, however, indications for its use. In. 
valuable animals, specially those of small species, it must be employed. 
MoUer has with complete success sutured in the dog the tibial nerve 
accidentally cut. 

Here is the mode of doing it : 

Assisted by his anatomical knowledge and armed with the necessary in- 
struments (bulldog forceps, scissors, bistouris, catgut threads, fine needles), 
the operator should expose both nervous ends. In recent wounds, he will 
find them with their normal characters ; their ragged ends should be 
smoothed over with the bistouri. In old wounds, the extremities are swollen, 
adherent to the surrounding vessels and united by a more or less solid struc- 
ture ; they must be slightly excised to bring in contact two fresh cuts. For 
the reunion, several ways offer themselves. A direct suture may be made by 
passing the thread in both stumps) ; the upper piece is first pierced 
through from forward backwards, at one or one and one.half centimeters from 
the cut, then the needle is made to pass through the other stump, this time, 
from backward forwards. In the penneurotic indirect suture the 
thread passes in the neurilematic envelop ; two stitches are sufficient 
to insure the coaptation, but often the sheath slips, tears, and it is then 
very imperfect. The parafieurotic suture does not involve the neurilemma ; 
it only encloses the surrounding connective tissue. Some surgeons apply 
four stitches, placed on the four sides of the nervous cords and including 
the sheath and the superficial fibres of the nerve itself (Berger). 

By using fine antiseptic thread (catgut or silk) and a needle of small 
caliber, the nervous cords stand well the direct suture. The peripherical 
end is held with the forceps, taking the neurilemma only ; it is run through 
with the needle and then the other end is secured. A knot regularly tied 
permits the perfect coaptation. The essential is to pass the threads near the 



TRAUMATIC LESIONS. 389 

■divided surfaces, so as to avoid the angular deviation of the united 
extremities. 

Such interferences are to be completed with an antiseptic dressing and 
immobilization of the leg or its fixation in such a position that the stretch- 
ing of the nerve shall be as slight as possible, — a condition which is some- 
times difficult to obtain with animals. 

If it has been necessary to cut off a small piece of the extremities of 




Suture of Nerves. 
Fig. 90. — Direct suture. Fig. 91. — Perineurotic suture. 

the nerve, it is sometimes impossible to bring the nervous stumps in con- 
tact. In such a case, the suture apart (at distance) with catgut threads 
and under most rigorous antisepsy is the preferred mode of operation. The 
leg placed in good position, peri and paraneurotic stitches will be applied 
to reduce as much as possible the separation of the stumps ; some direct 
points may also be made. It is rational to admit that the resortable 
threads act as guides to the young afferent neuricles of the central end, 
and prevent them from going astray (Forgue and Reclus). 



390 VETERINARY SURGICAL THERAPEUTICS. 

Regeneration of nerves is slow. In general, as we have said before, the- 
sensibility and motricity do not return for several months. 

In relation to the nerves that are incompletely divided, their complete 
section is no longer demanded. Consolidate the union of the two ends 
with a stitch, immobilize the part under an antiseptic dressing, is the indica- 
tion to follow. 

11. 
NEURITIS. 

In man, simple contusions, burns, frost-bites, bony or articular inflam- 
mations, tumors, not infrequently give rise to neuritis. These are ititer- 
stitial o\ parenchymatous, acute or chronic, descending ox ascending. 

These last, in which are several groups, are yet badly known. In the 
preceding chapter we have seen that the section of a nervous branch is fol- 
lowed with degeneration of the peripheric end and that it has no noticeable 
influence on the central stump. In ascending neuritis, there takes place 
in the central end, either a process similar to the wallerian degeneration 
(parenchymatous neuritis) or an inflammation of the perifascicular con- 
nective tissue, the lamellar envelop or the interfascicular connective tissue ; 
or again, the inflammation, both parenchymatous and interstitial, of 
the nerve. Some troubles at a distance (paralysis, anesthesia, amyotrophy) 
are explained by an ascending neuritis extending to the spinal marrow. 

For animals, if neuritis may complicate traumatic lesions of nerves, it 
is rare, and experimental studies have added nothing to the very incom- 
plete data given by clinical observation. 

" I have tied nerves in ligatures more or less firmly," says Vulpian. " I 
have squeezed them between two hard bodies, cauterized with various 
substances (cantharidine, liquid ammonia, acetic acid), pierced them with 
needles, without ever, obtaining a true suppurative neuritis, beyond the 
points submitted to the experimental violence." ' Charcot tells us also 
that experimental lesions, even the most serious, of the peripheric nerves, 
produce with difficulty, in most animals, a neuritis of some duration 
and like that which is developed, on the contrary, so easily in man after 
the slightest lesions.^ 

Whatever may be the special resistance of animals to the inflammatioa 
of nerves, pricks with crushing of the tubes, contused wounds or those made 
by foreign bodies, expose them more than clean sections. After the- 
operation of neurotomy, when the wound has suppurated, sometimes a. 

* Weir Mitchell. Des lesions des nerfs — Preface de Vulpian, p. XI. 
^ Charcot. Lesions stir les maladies du systime nerveux, p. 13. 



NEURITIS. 391 

•defective cicatrization takes place with formation of a large cicatricial 
tissue, painful, producing lameness : it is a plantar neuritis, which always 
remains limited. This neuritis and a pseudo-neuritis may be observed oa 
both ends of a neurotomized leg, even on both legs. It seems as if some 
subjects are predisposed to them. As for other tumors of nerves, ablation 
is followed by the removal of the lameness. Neurotomy performed above 
the neuritic portion has therefore its indications. 

In bovines, Gelle has described neuritis ( ?) of the branches which sup- 
ply the external face of the shoulder. Due to pricks of the pointed instru- 
ment which their driver uses as a whip, the sensibility would remain but 
motricity disappear, and back of the acromion, at its lower portion, a sub- 
cutaneous tumor, as big as a large pea, was observed. At the onset, Cruzel 
recommends long affusions of cold water, soothing unctions of althea oint- 
ment, camphorated or opiate populeum ; then, after a few days, frictions 
of spirit of turpentine. Soon improvement becomes manifest; regular 
exercise completes the recovery. 

Besides traumatic neuritis, toxic or infectious types are met in animals. 
In horses, neuritis of the recurrent has been observed during lead in- 
toxications. In cattle, after endometritis and peritonitis, Hamburger has 
observed neuritis of the median and of the crural. In the course of 
some infections, polyneuritis with muscular pains and sometimes subcuta- 
neous ademas resembling polymyositis, may occur. Polyneuritis a frigore 
seem rarer than polymyositis of the same nature ; but in hemoglobinuria, 
it seems that besides polymyositis there are often polyneuritis, as the par- 
alysis, anesthesia and rapid consecutive amyotrophy have a tendency to 
prove. The differential diagnosis is specially based upon the normal or 
painful state of the nervous cords of the affected surface. In polyneuritis, 
compressions exercised upon the course of nerves give rise to acute pains ; 
the same compressions are but little painful in polymyositis. 

It is to this variety of neuritis that must be added the alterations, so 
often observed in the femoral nerve, after " paraplegia." Goubaux has 
described them wrongly under the name of "neuromas" of the femoral. 
In reading the observations related by this author, it is seen that they affect 
animals suffering first with '-paraplegia" or " hemoglobinuria" and which 
remain lame on one hind leg. In all, he mentions the atrophy of the 
triceps cruralis. In Observation I, it is said : " The anterior femoral 
nerve was of a larger dimension than that of the opposite side ; it pre- 
sented in the middle of its extent a swelling, as big as a hazel-nut, grayish 
red in color ; in the middle of which the nervous fibres appear larger and 
with the cellular tissue surrounding infiltrated with serosity." And in Ob- 
servation II : " The anterior femoral nerve, at the place where it comes out 
of the pelvic cavity to ramify in the muscles, presented an elongated 



392 VETERINARY SURGICAL THERAPEUTICS. 

swelling, hard, of a grayish red color." These are the lesions of the 
post-hemoglobinuric femoral neuritis. 

Trasbot has thus described the alterations of the nerve when the affection 
is recent : " Its interfascicular connective tissue, extensively injected with 
blood, has a dark red color. Little by little this same tissue, partaking of 
the inflammation developed as consequence of the surrounding traumatism, 
vascularizes and swells ; the nerve, upon a length of five or ten centime- 
ters, presents then a fusiform swelling, whose transverse diameter may, in 
ii-s middle part, be two or three times the primitive size, which is preserved 
before and beyond the swelling. By simple dissection, it is observed that 
the nervous cords are isolated from each other, individually enveloped 
and compressed by the embryoplastic tissue now in process of formation." 
The treatment of this affection shall be indicated in the chapter on 
J^aralysis of the Femoral Neri'e. 

The therapeutics of neuritis varies with its forms. Prevent the cause is 
one of the first indications. For instance, by taking the precautions in- 
suring immediate cicatrization, one will have great chances to prevent 
neuritis of operation ; and if neurotomy is performed, by cutting the nerve 
as high as possible, near the superior angle of the incision. With toxic 
or infectious neuritis, the introduction in the organisms of nocive agents 
should be guarded against, their elimination favored, or antitoxic agents, 
resorted to to overcome their influence. When already neuritis is of some 
duration, the restoration of the nerve by hydrotherapy, electrotherapy 
(faradic or galvanic), massage and exercise will be indicated. Rheuma- 
tismal neuritis should be treated by salicylate of soda. Overwork and cold 
should be avoided. 

III. 

N EUROM AS— TU MORS. 

Most of the authors that have treated of neuromas have placed under 
that denomination all the tumors developed on the course of nerves. 
But only the rare neoplasms formed by nervous tissue of new formation de- 
serve this denomination ; the others are only fibromas, myxomas or lipomas 
of nerves. The painful products found at the extremity of nerves in some 
stumps of amputations are not neuromas ; neither are the pseudo-tumors 
■which fill up the wounds of neurotomy, no more than the callus or the 
cicatrixes of the tendons represent true neoplasms : they are the result of 
the inflammation of the nerve and belong to neuritis. The same exists for 
the post-hemoglobinuric " neuromas." 

Let us remark that in the generality of the cases published in veterinary 
medicine, histological examination has not been made. From the therap- 
eutical point of view, the true nature of these tumors is indeed of secondary^ 



NEUROMAS — TUMORS. 393 

importance, and whether it is for pseudo-neuromas, fibromas, myxomas, or, 
on the contrary, true neuromas, the treatment is the same. 

Rigot has several times found in the metacarpal or metatarsal regions, 
upon the course of plantar nerves, circumscribed nodosities, hard, varying 
in size from that of a bean to that of a pigeon's egg. Small, they were 
moveable under the skin ; large, they had contracted with it intimate ad- 
hesions. Very painful to pressure, they gave rise to lameness. The 
author describes them as follows : " They are composed of a very hard white 
substance, by which the nervous threads are separated and pushed out- 
wards, and spread round the tumor, flattened as little bands. In other 
cases, this scirrhous substance entirely surrounds the nerve, compresses it 
and forms with it an homogenous mass ; and again, in two of these 
tumors, the largest I have ever seen, I have found in their center a cavity 
containing a gelatiniform substance, mixed with a very small quantity of 
blood." ' 

Rey, Delwart, Lafosse, have reported also examples of " neuromas " or 
" tumors " developed upon nervous cords. 

What is the proper interference to use against these alterations, called in 
old times " ganglions of nerves?" Rigot and Lafosse have tried, in vain, 
alteratives, compression and actual cauterization. Iodide of potassium 
is without action. Excision is the only treatment that has been success- 
ful. A horse lame for two months on the left foreleg was operated by 
Rigot ; there was " on the course of the external plantar a tumor as big 
as a large bean, very hard, moveable, painful to pressure of the thumb." 
The animal was cast and the leg placed in proper position. The skin 
incised, the tumor and the nerve were exposed upon a certain length. 
The neoplasm was excised with the scissors. Immediately after the opera- 
tion the lameness disappeared. The wound healed rapidly. 

Lafosse found also on the inter plantar of one anterior leg a tumor, 
whose characters resembled those of fibromas due to the spiropterus 
reticulus : " The tumor had pushed forward the nerve, which was intact, 
except on its posterior border. It was composed of a fibrous tissue 
incrusted with small yellowish massed, hard, stone-like, similar to the 
tuberculous deposits so common in cattle." 

Interference varies in its details according to the more or less intimate 
connection of the nerve with the neoplasm. When the diseased nerve is 
small, it is excised ; but when it is an important trunk, it is possible to 
preserve it if the tumor is pedunculated, hanging to the nerve and resting 
on it, as in the case of Lafosse. When the tumor is central, sur- 
rounded by flattened nervous filaments, one might, under anesthesia, 
incise the nerve, and enucleate the neoplasm in preserving intact the con- 
^ Rigot, Rec. de Med. Vet., 1S29, p. 462. 



394 VETERINARY SURGICAL THERAPEUTICS. 

tinuity of the organ. If the tumor envelops the nerve entirely, it is excised 
on one of its faces and each half removed one after the other. At times 
the nervous filaments and the neoplasm are intimately entangled ; the 
separation is impossible ; the whole mass must be excised. 

For painful cicatricial parts which succeed neurotomy, excision is the 
most efficacious treatment. The central end of the nerve is isolated, and 
separated on a healthy portion ; the neoformed fibrous product is then dis- 
secl^ed. It is ordinarily found intimately adherent to the tissues under- 
neath. Trasbot has thus removed a tumor in a horse, whose size 
was about that of the small finger ; its tissue was white, slightly grayish, 
very firm and hard like fibrous tissue ; the nervous threads run through it 
separated, leaving between them quite thick layers of that tissue. 

Neuromas of stumps of extremities are also treated by ablation. 

The generalized neuromas, which transform the nerves in true bead- 
roll of tumors, are seen only in cattle (Colin, Morot). The cow of Colin 
had shown no ailment during life ; at the post-mortem, tumors were found 
in the brachial plexus and in all the sympathetic system. At the lumbar 
region, they formed a mass weighing five pounds. The pneumogastrics, 
cervical and subcostal threads of the sympathetic, the inferior cervical 
ganglions and several nerves of the head had isolated tumors of all sizes, 
varying from that of a pin to that of a goose's egg. From the observations 
of Morot, it seems certain that these neoplasms, are not rare in bovines. 
During 1885, this author found them in eleven cows; two of them 
had more than 120, one more than 100 and two more than 80. The 
nerves of the dorsal, costal and sternal regions, as well as those of the 
legs and of the posterior parts of the neck, were affected. The situation of 
these tumors is most variable : " Some, situated directly under the neuri- 
lemma, are visible by transparency. The others are difficult to be seen, 
being imbedded among the central nervous threads. By exploration of 
the course of the nerves, they are readily perceived, rolling more or less 
under the fingers." 

It is surprising that such extensive alterations of the most sensitive tissue 
of the organismishould remain absolutely silent. As Tillaux remarks, in man, 
if pain was proportional to the number of the neoplasms, life would be un- 
bearable with such etherism of the nervous system. But as much as 
solitary neuromas are painful, as much those bead-rolls of tumors seem 
compatible with the regular execution of all functions. If lameness or 
manifest pains would occur and that interference would be desirable on 
valuable animals, this would be guided by the results obtained in man. 
Bromide of potassium has proved advantageous (Nicaise) ; aconite, 
antipyrine, salicylate of sodae has given good results. Only the large 
neuromas producing pain exceptionally may necessitate extirpation. 



NEURALGIAS. 395 

IV. 
NEURALGIAS. 

Pains situated along the course of ner\'es most commonly result from 
■congestion, compression or inflammation of these organs ; but sometimes 
they show themselves without any apparent alteration having taken place in 
the nerves. Neuralgias then represent a syndrome related to several pro- 
cesses ; some well known, with manifest lesions of the painful nerve ; others 
of nature yet unknown. Hence, the division into neiiritic-neuralgias and 
ncjiroses-neuj-algias. In animals, more or less acute pains, due to nervous 
lesion, are commonly observed. By analogy to what takes place in man, 
animals are also subjects to jieuroses-neuralgias. ^\\q facial neuralgia would 
produce a kind of " symptomatic ophthalmia with redness, tears flowing 
and photophobia, a little nasal discharge and ptyalism. The horse has 
the eyes staring and brilliant, he moves his ears, lays them back as a 
vicious animal, bends his head towards his leg, and manifests his pains by 
groans analogous to that seen in animals on which a twitch is applied, 
and by kicks against his stall" (Renner). Sciatic or femoro-popliieal 
neutalgia is accompained " by shakings and lameness of the affected leg ; 
moving and exercise increase the pains, specially when the foot rests on 

the ground Sometimes, as characteristic in animals, tremblings of 

muscles have been observed, giving rise to access of pains ; also weakness 

of the leg, which is half paralyzed "' (Zundel). Certnco-brachial 

neuralgia is accompanied by a continued or intermittent lameness with pain- 
ful spots on the course of the nerves. Descriptions have been given of a 
cervico-occipital neuralgia, which may be mistaken with torticolis — a dorso- 
intercostal neuralgia, with pains during respiration ; — a lumbo-abdominal 
neuralgia, with pains in the loins. Zundel speaks also of neuralgias of 
the mammae and of the testicles. Moller has several times observed the 
hyperesthesia of some cutaneous regions, without material lesions or 
marked alterations. He considers as neuralgic in nature the intermittent 
hyperesthesia of the poll and of the withers, brought on by frictions of 
the harness and which is increased by the slightest pressure. He says 
he has observed frequently neuralgias in the surface of distribution of 
the occipital nerve. 

In some of the cases of femoro-popliteal or sciatic neuralgia related in 
horses, cattle, goats, the nature of the affection is at least doubtful. The 
same can be said of the brachial neuralgia of Cantoni and of most of the 
observations of this kind. 

It goes of itself that the diagnosis of " neuralgia " must be made ia 



39^ VETERINARY SURGICAL THERAPEUTICS. 

animals with a great deal of reserve and after repeated examinations, irt 
dogs especially, where rheumatic pains are very common, and might be 
taken for neuralgia. 

Neuralgia is treated by local means and internal medication. Sooth- 
ing compounds and antispasmodics, specially bromide of potassium, vale- 
rian, asafetida, camphor, opium, belladonna, aconite, have been tried. 
To-day morphine injections, antipyrine, cocaine, hold the lead in anti- 
neuralgic medication. 

Upon the course of the supposed diseased nerve, cataplasms, oils of 
hyoscyamus, of belladonna, blisters, points of firing, subcutaneous local 
injections of morphine and atropine, are useful. Some authors recom- 
mend massage, acupuncture, electricity. Sometimes the general condi- 
tion of the patient must be looked after. Anemic animals should receive 
iron and quinine ; rheumatic patients, salicylate.of soda. 

Against some rebel neuralgias, more active treatment is required. Two 
methods are left to the surgeon's choice ; stretching of the nerz'e and 
neiavtomy. The first diminishes the transmission of sensibility of the 
nerve without changing the motility. On the contrary, neurotomy sup- 
presses all nervous current, and if it is completed by neurectomy (removal 
of a piece of it), the regeneration of the nerve is more or less postponed 
and therefore also the reappearance of the sensibility. These two rival 
modes are not judged yet by veterinarians. However, neurotomy is more 
familiar to them, and it is used for many painful conditions that have 
remained rebel to ordinary therapeutic agents. 

V. 

PARALYSIS. 

Under this name or that of akinesia is understood the abolition or 
diminution of the contractility of muscles through their normal 
stimulant. The simple diminution of muscular contractility is some- 
times designated under the name of paresy. The loss of sensibility to 
pain or to touch {atialgesy and afiesthesy) often exist with akinesia and 
furnishes important elements of diagnosis. We have spoken of myopa- 
thic paralysis in studying the diseases of muscles ; we will here treat only 
of the neuropathic paralysis. 

They present themselves under very varying forms, among which are : ist,. 
local or isolated paialysis, involving one or several muscles of the same group, 
sometimes several muscular groups ; 2d, monoplegia or paralysis involving 
a whole leg, and of cerebral or spinal origin ; 3d, hemiplegia or paralysis of 
one lateral half of the trutik ; 4th, paraplegia or paralysis of the hind 
quarters ; ^"Ca.^ associated paralysis ; 6 th, diaplegia or diffused paralysis^ 



PARALYSIS. 397 

At times the paralyzed muscles are flabby and relaxed ; if it is in one leg,. 
one can move it in all directions without the slightest resistance {^flaccid or 
relaxed paralysis ) / at others, but less commonly, the muscles are stiff, 
con trac ted ( spastic pa ralysis. ) 

Neuropathic paralysis are only symptoms common to various lesions of 
the brain, of the cord or of the nerves. To treat them rationally, it is 
necessary to determine the seat as well as the lesion of the existing 
lesions. There are cases where the impossibility of standing (paraplegia), 
the lameness (paralysis of the femoral), the mode of carrying the leg 
(paralysis of the radial), the aspect of the region (paralysis of the facial) 
immediately give information. But in others, the diagnosis is difficult. 
The sensibility, the reflexes, the electric contractility may give valuable 
assistance. 

The sensibility may be increased, diminished or perverted. In animals, 
general sensibility is tested by pricking or burning. Generally the dimi- 
nution of sensibility is located on the same side as the paralysis ; yet 
hemiplegia can exist on one side and hemianesthesia on the other. The 
examination of special sensations (hearing, sight, smell) is also very impor- 
tant. Difference in the pupils, myosis, mydriasis, absence of pupillar 
changes by light, indicate lesions of the encephalon, cervical cord or 
sympathetic. 

Tendinous reflexes (patellar reflex, that of the tendo-achillis) are nor- 
mal, exaggerated, diminished or suppressed. Their mechanism is known : 
the mechanical irritation, carried to the gray substance of the cord by the 
centripetal fibres and the posterior medullar roots, is propagated to the 
motrice cells of the anterior horns of the cord, where it is transmitted to 
the muscles by the peripheric motrice ways. The integrity of the 
*' spinal reflex current " is the condition of the presence, in the normal state, 
of tendinous reflexes. They are diminished or abolished with lesions in- 
volving the centripetal or centrifugal nervous fibres, or the anterior or 
posterior roots of the marrow, or again .the gray medullary substance. 
And as there exists in the encephalon and the superior layers of the cord, 
moderating:; centers of these reflexes, one may understand how the lesions, 
which involve the brain and the anterior half of the cord and suppress the 
influence of these centers upon the inferior regions of the spinal marrow, 
may produce an exaggeration of these reflexes. That is what occurs in 
many circumscribed medullary affections, which leave intact the reflex 
spinal arch. 

Electric exploratiofi (faradizatiofi or galvanization ) gives also useful 
indications. The electric muscular contractility is preserved in paralysis 
with cerebral origin and in some paralysis with spinal origin (when 
the segment of the cord, which innerves the paralyzed muscles, is in- 



398 VETERINARY SURGICAL THERAPEUTICS. 

■ demne); it is abolished in spinal paralysis with disorganization of the 
medullary segment corresponding to the paralyzed muscles, and in trau- 
matic peripheric paralysis, a frigore or toxic (reaction of degeneration.) 
The lasting abolition of electric contractility of paralyzed muscles is an 
indication for bad prognosis. It coincides with the loss of the reflexes 
and is soon accompanied with the atrophy of the affected muscles. 

Let us resume the principal characters of /ara/i'j-/^ ay/V// cerebral origin, 
of those with medullary origin, and of those with peripheric nenwus 
origin. 

In general, in cerebral paralysis, there is hemiplegia of ike opposite side 
of the lesion, and the cranial symptoms allow us to differentiate the cerebral 
from the spinal hemiplegia. Ordinarily the sensibility is preserved ; when 
there is anesthesia, it is hemiplegic and is situated on the same side as the 
motrice paralysis. Bilateral alterations of the brain and those of the 
mesocephalon may produce paraplegia. Lesions of the cortical layer of the 
brain give rise to various paralysis ; motrice fibres having their origin in 
the gray substance of the cerebral cortical portion and the psychomotors 
being independent, autonomous, if the cortical lesions are circumscribed 
they only give rise to monoplegia or local paralysis. But, here again, the 
encepnaiic symptoms often allow a positive diagnosis. Some paralysis of 
encephalic origin are alternate ; the face is paralyzed on the side of the 
lesion ; the legs on the opposite side — a peculiarity due to the bulbar de- 
cussation of the pyramidal fasciculi, which transmit the will of the motrice 
regions of the brain to the different sections of the spinal cord. An 
encephalic morbid center which is, for cranian nejt'es, a peripheric lesion 
and involves the pyramids above their decussation, promotes a crossed 
paralysis or alternate hemiplegia. The typical paralysis of the annular 
protuberance is the alternate hemiplegia ; that of the bulb, the labio- 
glosso-pharyngeal paralysis. 

Paralysis of ffiedullaty origin are almost always ordinary paraplegia, 
limited to the posterior legs ; sometimes the anterior are also affected 
(cervical paraplegia) . In the cord, the ways of conduction being very near 
each other, lesions, even small, produce easily those bilateral paralysis ; but 
very limited alterations may give rise to hemiplegia or monoplegia, then 
the suppression of the motility is always direct. The troubles of sensibil- 
ity are various ; in general, anesthesia is paraplegic ; if it is hemiplegic, it 
is situated on the opposite side to the lesion : at times anesthesia is only 
in spots. When the cord is destroyed in all its thickness, reflexes which 
have their center below the region are exaggerated. Muscular atrophy is 
frequent. Some characters permit also to recognize the localization of 
the lesion upon the cords or upon the gray substance. The alterations of 
this last give rise to paraplegia, all reflexes corresponding to the diseased 



PARALYSIS. 399- 

TCgion have disappeared, the atrophy of muscles is rapid, there is diminu- 
tion of the electric excitability and reaction of degeneration partial or 
complete in the paralyzed structures. 

Paralysis of peripheric nervous origin — the ones that we have particularly 
in view — are generally limited to a single nerve or to a group of nerves in 
the neighborhood, and rarely do they involve a great number of muscles. 
At the same time that the paralysis of motion, anesthesia and trophical 
disturbances are observed, ordinarily precocious, which little by little be- 
come more marked, reflex excitability is destroyed. Electric explora- 
tion is not slow in giving the reaction of degeneration.^ 

To establish a rational treatment of akinesia, the nature of the lesion 
and cause of it must be known. Ischemia and congestion, hemorrhage, 
softening, acute or chronic inflammation, tumors, various infections or 
intoxications, are as many morbid processes liable to act on the nervous 
system and promote paralysis very variable in their seat and in their march. 
Paralysis occurring i-apidly are due to mechanical, toxic or infectious 
causes, according to the cases : nervous compression, cerebral or medul- 
lary hemorrhage, intoxication by vegetal or mineral poisons, infection and 
intoxications by microbian poisons. Paralysis progressing sloivly zwwowncQ. 
a chronic inflammation or a neoplasm. 

In the chapter Diseases of tlie Brain and Cord we will come back on 
the paralysis of cerebral and those of spinal origin. Several local parahsis 
will be studied with other affections of the regions where they are met. 
We will here consider specially the akinesia of extremities. 

From what has been said above it is seen that local paralysis are ordinarily 
determined by various causes which abolish the functions of a nerve by 
destroying its continuity or altering its structure : by section, com- 
pression, distension, laceration of the nervous branches, neuritis and 
neuromas. It is sometimes difficult to learn their precise nature. Some 
are of infectious or toxic origin. Often paralysis of unknown origin are 
attributed to rheinnatisnt, when most commonly they are the result of a 
slip, a fall or perhaps of an infection or intoxication; we hold that 
truly rheumatismal paralysis or afrigore are very rare in all animals. Some 
are peculiar to some species ; we meet with diphteritic paralysis only in 
aviary species. 

According to their origin and the importance of the organs affected, 

1 The reaction called degeneration is partial or complete. Specially accused in 
traumatic paralysis consecutive to the section of a nerve, it has for principal characters : 
diminution or loss of the excitability of the nervous trunk by faradic and galvanic cur- 
rents; the persistency or even the exaltation of the galvanic contractility of muscles, in 
contrast with the diminution or abolition of the faradic contractility ; the slowness of 
the muscular jerking. 



400 VETERINARY SURGICAL THERAPEUTICS. 

local paralysis have a gravity which varies much. The altered, divided 
nerve, more or less degenerated, may resume its role of conductor, but 
often recovery is slow. When it is a question of the nerve of legs, and that 
lameness prevents its utilization, there are cases where treatment cannot 
be undertaken except for costly animals. 

Rheumatismal paralysis are ordinarily benignant. Almost always they 
disappear in a few weeks. Those due to slight traumatic lesions last 
sometimes only a few days ; serious lesions of same nature bring on 
paralysis of long duration, sometimes permanent. While the paralysis of 
the radial nerve recovers almost always, that of the sus-scapuiar is per- 
manent in most cases. The incurability of the paralysis of the recurrent 
is explained by the constant compression on the nerve through the hyper- 
trophied glands. The atrophy of the muscles is always a sign of bad 
prognosis. The persistency of the faradic irritability is a favorable sign : 
its exaggeration is a sign of early recovery. Incomplete paralysis, specially 
those of traumatic origin, generally end favorably and in a short time. 
It is known that most paresis of the radial nerve almost invariably get 
well in two or three weeks. The older the paralysis is and the atrophy 
marked, the more serious is the prognosis. 

The means of treatment vary with the nature of the trouble. In case 
of compression by a callus, a tumor, a cicatrix, the sharp instrument 
must be resorted to. Paralysis that are produced by infiltration in recent 
traumatic lesions have a natural tendency to diminish by degree and at 
last disappear by the natural process of the cause. It is indicated to act 
at the same time on the nerve and on the muscles. When possible, 
recourse to electrotherapy is indicated, to shorten the duration of the 
disease as well as to prevent the muscular atrophy. Electricity is a 
powerful assistant, either by stimulating the nerve or exciting the mus- 
cular contractility. The negative pole (cathode) should be placed on the 
region corresponding to the nervous trunk or on a point where it is most 
superiicial, and the positive pole (anode) upon the muscles where the 
nerves ramify. The seatings of electrization will last four or five minutes, 
and will be renewed every day, or from eight to ten minutes, and given 
every second day. The current should be weak, and strong ones always 
avoided, as being very painful. Often action is to be limited only on the 
muscles. The atrophy will be prevented by exercise ; massage, blisters, 
cauterization, subcutaneous injections of veratrin, strychnine, salt-water have 
proved advantageous. In all cases existing for a short time, iodide of 
potassium is indicated ; it promotes resorption in perineurotic effusions. 
With rheumatismal paralysis, salicylate of soda will be prescribed. 

One must not take for paralysis the muscular atony some\.\m.e% observed 
in colts and in calves, in the first days following birth. Most often, the 



PARALYSIS. 



40 r 



extensors of the metcarpus and of the phalanges are affected in the fore- 
legs, and the flexor metatarsi in the hind. Recovery is ordinarily easily- 
obtained by massotherapy, and simple dry frictions. 

Local Paralysis of ExtreiMities. 



Se 



I.— Sus -Scapular Nerve. 

The sus-scapular nerve, which ramifies in the antea and postea spinatus 
muscles, can be injured in various circumstances : by bruises against the 
shoulder, especially those which occur from forward backward when the 
leg is raised to be car- 
ried forward (M oiler) 
or by a blow, at the 
time of a fall, or by a 
slip in abduction. In 
army horses it has been 
observed without be- 
ing able to attribute 
it to any other cause 
than powerful muscu- 
lar efforts or suddenly 
executed movements. 
We have observed it 
after the securing in de- 
cubital position. After 
two months the atrophy 
of the subspinatus spe- 
cially was well marked. 
(Fig. 92.) Under the 
title of Laceration of 
the Tendotis of the 
Subspinatus, Bouley le- 
lates two similar facts. 
(See Tendinous Rupt- 
ures.^ In some cases, 
it is rheumatismal in 
nature or related to hemoglobinuria. For Biot, it is muscular congestion 
which, giving rise to ''hemorrhagic raptus," injures the sus-scapular; the 
sweenied shoulder is but " the consequence of the compression and in- 
filtration of the sus-scapular, by blood extravasated in nature round it and 
in its structure." 




Fig. 92. — Paralysis of the sus-scapular nerve (from a 
photograph). E, projection formed by the scapular 
spine ; Se, depression due to the atrophy of the postea- 
spinatus muscle. 



402 VETERINARY SURGICAL THERAPEUTICS. 

This paralysis of the antea and postea spinatus is ordinarily indicated 
by slight continued lameness, which, at the outset at least, is sometimes- 
difficult to connect with its true cause. At rest, the leg is carried a Uttle 
forward of the plumb line, the scapulo humeral prominence is carried 
outward. In walking, the movement of the leg forward is stiff ; at the 
time of putting the foot down, the shoulder angle is more prominent than 
the other and is carried in abduction. Later, when the atrophy of the 
sus and sub-spinatus muscles or of this one alone is well accused, the seat 
of the disease is evident. Then the lameness becomes more manifest 
after a certain length of work and the animal is unfit for fast work. 
Goubaux has related an interesting case of paralysis of the sus and sub- 
scapular nerves and of the axillary, observed in a horse, which, while 
galloping, had run against the hub of a truck. The shock brought on an 
immediate lameness which resisted several treatments. Two months 
after the accident, the shoulder was thinned, atrophied, the elbow greatly 
bent outwards with a deviation which increased during walking. At the 
moment of rest, the weight of the body produced a certain amount of 
dropping of the extremity. At post-mortem a marked atrophy of the 
sus and sub-scapular muscles was found, also of the long and short abduc- 
tors of the arm and of the sub-scapularis. 

Recovery occurs in about half of the cases. Moller out of ten observa- 
tions, obtained three recoveries, three improvements and four failures. 
Traumatic paralys-is implies a more serious prognosis than those of rheu- 
matoid nature. When the atrophy is already great, in general all treat- 
ments fail. Revulsive frictions, firing, irritating subcutaneous frictions 
form the base of the therepeutics. Electricity, used as we have said, may 
render some service. Hansen says he obtained good results with hypo- 
dermic injections of spirits of turpentine. We prefer the subcutaneous 
injections of veratrine solutions (veratrine lO centig. ; water 5 grams.) 
According to Goubaux, many have seen this paralysis resist to the firing 
of the shoulder. But the lameness is slight, and allows the use of the animals 
at slow work. 

//. — Brachial Plexus. 

This paralysis is sometimes of encephalic origin ; in this case, it is 
preceded by other troubles, which may appear with it or after. In a 
horse affected suddenly with paralysis of the right hind leg, and two days 
later with a paralysis of the anterior corresponding leg, at the au- 
topsy, hemorrhage of the cerebellum was found. Another horse which 
presented symptoms somewhat similar recovered after three weeks. 

Very generally this paralysis is due to local causes ; a sub-scapular 
hemorrhage (Holniann), a deep abscess, a tumor of the internal face of^ 



PARALYSIS. 403 

the shoulder. It often occurs as accident of casting. When one of the 
anterior extremities remains for a long time in crossed position, the plexus 
may be bruised or compressed between the shoulder and the trunk ; when 
the animal is up, a more or less complete paralysis of the extremity is 
observed. Almost always it is the leg upon which the animal is lying 
which is affected ; the accident may occur even when the leg has not 
been displaced. The horse of which Trasbot speaks lay on the right 
side, and the left anterior leg secured above the corresponding hock ; 
the right foreleg, left in the hobble, was the one which became para- 
lyzed. 

According to the degree of the lesions, one will observe a paresis of the leg 
with tremblings of the olecranon muscles, but these will ordinarily disappear 
rapidly ; at other times, when paralysis is complete, the inert extremity is 
dragged upon the ground, carrying weight is impossible, the articulations 
flex under it. The troubles of sensibility are less clear. When motility 
is abolished, sensibility may yet persist normal or be only diminished. 

The treatment must necessarily vary according to the producing cause. 
Large callous tumors prevent interference. If an abscess develops under 
the shoulder, in the depth of the axilla, pressing upon the plexus, it must 
be opened early. A bloody effusion is less dangerous ; ordinarily it 
resorbs by degrees and the leg recovers its motility. 

We treat the paralysis of casting by immobilization, stimulating frictions 
(camphorated alcohol, charge of Lebas, blisters) and by the daily admin- 
istration of 10 or 20 grammes of iodide of potassium. Irritating sub- 
cutaneous injections may be used with advantage. Trasbot's patient was 
first left alone on a thick bed, but, on account of threatening bed sores, he 
was placed in slings. The twelfth day, as the fore-leg was improving, 
general troubles occurred, the right hind leg was paralyzed in its turn ; 
complications due to "ascending neuritis, spread to the spinal cord.'* 
Recovery took place, however, rapidly. 

///. — Radial Nerz^e. 

The radial, ox posterior humeral 7ierve, is the largest of the branches of 
the brachial plexus ; it twists around the shoulder joint, reaches the internal 
of the humerus, its posterior face, then the anterior face of the elbows and 
that of the radius ; it ramifies in the extensors of the fore-arm, those of the 
metacarpus, the external flexor of the metacarpus and the two extensors 
of the phalanges. This paralysis has been frequently observed in horses 
sometimes in cattle (Harms) and dogs (Moller). We have seen numerous 
cases in horses and one in dog. 

Like the preceding, it is generally due to the securing of horses in 



404 



VETERINARY SURGICAL THERAPEUTICS. 



decubital positions ; the nerve is squeezed between the thorax and the 
leg, specially if this one is in crossed position. It may arise from other 
causes (traumatisms, fractures, tumors). Goubaux accuses falls and con- 
tusions ; Tondeur has recorded a case due to a kick. Sometimes it arises 
from strong and repeated contractions of the muscles, which the nerve 
ramifies (Werner), or from struggles made to relieve himself from hobbles 
(Weber). Benjamin has treated a six year old horse, phlethoric, taken 
with paresis while working : harnessed to a heavy load and obliged to 
make violent efforts, the horse suddenly fell, could not rise except with. 




Fig. 93. — Complete paralysis of the radial. (MoUer.) 

difficulty, and presented symptoms of cerebral hyperemia, of inco-ordina- 
tion of motions in the anterior extremities, and lastly in the right leg, and 
the functional troubles resulting from incomplete paralysis of the radial. 
Often this becomes manifest after a quick and long race. Brauer has 
seen it after a long exposure to cold rains (rheumatismal paralysis). In 
one horse at our clinics, it occurred at night, probably from defective atti- 
tude or from a slip. Bowmann and Brauer have related cases of double 
radial paralysis, occurring suddenly. Moller has seen that of the left 
nerve to be complicated in a few days with that of the right. In a case 



PARALYSIS. 405 

observed by Fries, it became complicated after some time with paralysis 
of the opposite hind leg. 

The diagnosis is not difficult. la a certain number of cases, paralysis 
is incomplete or partial : at rest, the standing is normal, sometimes there 
are twitchings of the olecranon muscles ; in walking, the leg is carried 
forward with the joints semi-flexed, the foot drags on the ground. In 
very slight cases, the trouble is manifested only by slightly marked symp- 
toms ; but in quick gait, the legs flex to excess and the animal may fall. 
When paralysis is complete, the standing of the leg and the lameness are 
characteristic : at rest, the shoulder is depressed, the scapulo-humeral angle 
wide open ; the olecranon muscles are relaxed, their mass less prominent ; 
the elbow and knee joints are flexed ; the extensors of the phalanges are 
paralyzed ; the flexed fetlock is carried forward ; the toe of the foot is 
sometimes on a level with that of the other leg, or again in front or back 
of the plumb line. The standing takes place on the toe or the anterior 
face of the foot and digital regions. Walking is very difficult ; the leg is 
more dragged than carried forward ; in the slightest standing, all joints 
are flexed. In a horse observed by Tondeur, the nerve having been 
bruised very low, where it leaves the groove of torsion of the humerus, the 
extensors of the forearm were not paralyzed, but the anterior extensor of the 
metacarpus and those of the phalanges functioned poorly and when walk- 
ing was hurried the fetlock struck the ground. Changes in the sensibility 
are far from being proportional to the degree of the paralysis; even when 
this is complete, sensibility may remain well marked. 

The prognosis varies with the cause of the paralysis and the intensity of 
the symptoms. In few cases, the affection is very serious. Goubaux 
records the observation of a subject which had to be destroyed the eighth 
day. We have seen a similar case : the paralysis was due to securing in 
crossed position ; the animal was placed in slings, and kept there for a 
week ; he had to be removed from them, when he dropped and died six 
days after. 

These are exceptional cases. With this akinesia, whose symptoms 
are sometimes so alarming, rapid recovery is the rule. Twenty horses 
treated by Moller all made a recovery. Often improvement is manifested 
after one, two or three weeks ; sometimes the symptoms remain in the 
same condition for several weeks and then disappear in a few days. Like 
Lustig and Moller, we have seen radial paralysis which did not disappear 
except after a long treatment. Moller mentions a case where recovery 
did not occur for nine months. To give up treatment too soon, because 
the symptoms persist at the same degree for several weeks, is a fault which 
one will not commit if the habitual march of the disease is known. On 
the horse shown in fig. 94 the paralytic troubles lasted for a month before 



4o6 



VETERINARY SURGICAL THERAPEUTICS. 



noticeable attenuation showed itself. A week later, he walked better. lit 
two weeks he resumed work. 

In all the cases where the paralysis is complete, it is always well to use 
slings, until the time when improvement is noticed, and even as long a 
time as the patient will stand them. The principal agents of the local treat- 
ment are revulsives, blistering agents and electricity. Goubaux resorted to 
the following treatment in one case : " Two needles, 15 centimeters long, 
were thrust half their length, one in the large extensor of the forearm, 
back of the scapulo humeral joint, the other in the short extensor of the 
forearm, near its insertion to the olecranon. Both needles were attached to 




Fig. 94. — Paralysis of the radial on the road to recovery. (From photograph.) 

the poles of an electric pile. Each time the current was closed, muscular,, 
violent and jerky contractions would take place, moving the leg a little in 
all directions." Several seatings of ten minutes of this electrization were 
applied. The fifth day, the olecranon muscles, first flabby, had returned 
to their size and consistency, the animal was no longer lame and returned 
immediately to his work. Inductive instruments have considerably sim- 
plified the treatment by electricity and still it is little used in our animals 
(see Paralysis in General). 

Blisters are used oftener. Goubaux has called attention to their 
good effects. The charge of Lebas or blisters are generally used. We 
prescribe a blistering application on the external face of the arm, and. 



PARALYSIS. 407 

.administer 10 or 20 grammes of iodide of potassium. As soon as im- 
provement appears, short walks, morning and evening, gradually increased, 
are beneficial. Subcutaneous injections of strychnine (o gr. 025-0 gr. 05) 
or of veratine (o grs. 10), made in the affected region, are recommended 
by Bormann and Moller. Those of salt water or spirits of turpentine may 
also be useful. 

The treatment of incomplete paralysis is the same. The animal should 
be put in slings or left loose in a box-stall ; locally, revulsives and blisters 
should be used. 

IF, — Obtit7-aior Nen^e. 

This is generally mentioned only as consecutive accident of dystokial 
labors and fractures of the pelvis : it is produced by active pressures made 
upon the nerve on some points of its course, most commonly at the 
obturator foramen, either during the passage of the foetus or by effused 
blood or again by a large callus. In all species, it may also be due to 
neoplasm of the neighborhood of the nerve ; it has also been observed in 
white horses affected with melanosis of the pelvis. 

At rest, the leg is carried more or less in abduction, the joints are 
flexed, the toe of the foot turned outwards. In walking, the extremity is 
moved with difficulty and with a motion of abduction. Little by little 
there is atrophy of the muscles where the nerve ramifies — adductors of 
the thigh, pectineus, short adductor of the leg. This atrophy with the 
conditions detected by rectal examination confirm the diagnosis. 

Against paralysis due to tumors or a callus, there is nothing to do. 
For those of dystokial origin, "irritating frictions on the croup and thigh" 
have been recommended. Cold irrigations of the vagina and massage 
through its walls should be more efficacious. At times improvement 
■occurs rapidly, even when no treatment is carried out ; quite often the 
lameness does not disappear for months, sometimes it remains permanent. 

V. — Femoral Nen'e. 

It is no doubt to " hemoglobinuria " or " congestion of the spinal cord " 
that most cases of femoral paralysis are due. Goubaux, Bouley, Reynal 
saw in it the consequence of rupture of the 'psoas, which is " of such 
delicate texture that it tears with the greatest facility, during life as after 
death " (Rigot). But paralysis of the triceps cruralis may appear at the 
onset of the disease, and at the autopsies of all the horses which had it, no 
lesions of the psoas could be found. In these cases it was either a myo- 
pathic paralysis, or a femoral neuritis, due, as myositis are, to rheumatismal 
or infectious process. 



408 VETERINARY SURGICAL THERAPEUTICS. 

Among the post-hemoglobinuric symptoms, the most frequent is atrophy 
of the crural muscles, which is easily reproduced experimentally, as 
Goubaux did, in performing the division of the nerve " at the internal face 
of the thigh, on its superior portion, between the vastus internus and 
the anterior straight, where it furnishes its terminal branches." ' This 
amyotrophy, generally evenly accused to the three parts of the triceps, is 
neuritic and not myopathic in origin. 

At any rate hemoglobinuria is not the only affection able to produce 
the paralysis of the femoral nerve and its characteristic symptoms. It is 
useless to repeat here the causes already mentioned in the chapter on 
paralysis in general : abscesses, tumors, exostosis, intoxications. The 
first observation of the report of Goubaux had his foot caught between 
two stones of street pavement ; he made a violent effort, tore his shoes, 
and became suddenly lame. Like the lameness resulting from section of 
the femoral nerve, this did not give away to firing applied on the thigh. 
At post-mortem, lesions of the great psoas and inflammation of the 
femoral nerve were found. Schmidt related a case with similar etiology. 
The patient of the second observation was affected with paralysis after a 
violent effort, and that of Observation VI after a fall. The horse treated 
by Trasbot had kicked in harness with both legs ; the right foot, held back, 
was carried in forced abduction ; " the psoas torn at the moment of the 
accident brought on a severe neuritis which demanded several months to 
get well." Gunther had already mentioned kicking backwards as a cause 
of femoral paralysis. i\Ioller has seen six cases due to powerful muscular 
contractions. 

Whatever may be the cause, the lameness of femoral paralysis is in all 
cases very expressive : the sudden flexion of the stifle and hock joint, every 
time the animal rests on the leg. The atrophy of the patellar muscles, 
gradually manifested, is another unmistakable sign. 

The treatment of femoral paralysis which occurs as prodome or symp- 
tom of hemoglobinuria is connected with that of this last affection. To 
treat post-hemoglobinuric paralysis and those of other origin, all vesicating 
agents have been used. But cauterization is to be preferred. It is one 
of the affections where lines firing is specially indicated. Goubaux has 
tried electricity. A mare affected with this disease was cast; "two 
needles were thrust into the fleshy tissues, one on the anterior part of the 
croup pointing towards the lumbar region, the other at the lower extrem- 
ity of the femur in the anterior femoral muscles. The needles were con- 
nected with a galvanic pile, and the parts included between them 
submitted to electric current for twenty minutes. Under this influence 

1 Goubaux, Rec. de Med. Vet., 1844, p. 492. 



PARALYSIS. 



409 



the leg executed numerous and violent contractions, which returned every 
time the current was turned on." The seatings were not sufificiently repeated 
to insure a noticeable result. While Goubaux doubted the possibility of 
recovery, all the subjects treated by Lebel with blisters and exercise re- 
covered in a few months. 

In many cases, exercise and time are sufficient for a recovery (Bouley). 
The patients should be left loose in a box ; they will be turned out. The 
degenenation of the muscles will be prevented by daily massages, the ap- 
plication on the external surface of the thigh of repeated stimulating or 
blistering frictions or by firing. Subcutaneous injections of veratrine 




^'£, 



Fig. 95. — Paralysis of the femoral nerve. (From a photograph.) 

(o gra. 10) have a decided advantageous action. Saturated solution of 
salt is less efficacious and sometimes gives rise to rather extensive under- 
mining of pus. 

We prefer iodide of potassium (10 or 20 grammes a day) to nux 
vomica. As soon as walking is possible without being too tiresome, the 
patient should have light exercise. The atrophy of the patellar muscles 
is sometimes well marked, but nevertheless, for it also, recovery is the 
rule; after three to six months, the muscles have generally resumed their 
normal contractility and size. Incurable cases are almost all hemoglo- 
binuric in their origin. 



410 VETERINARY SURGICAL THERAPEUTICS. 

VJ. — Great Sciatic. 

Well protected at its origin by the thick layers of the gluteal muscles, 
the gt'eat sciatic is seldom affected, yet its paralysis has been observed in. 
horses and in dogs. Ordinarily due to the forced extension of the hind 
leg, in a slip or by a fall on the hind quarters, it is characterized by the 
inertia of the totality of the muscles of the hind leg, except the triceps, 
which is innerved by the femoral ; the paralyzed muscles become atrophied 
with time. Rodet has related the observation of a horse affected with a 
special lameness due to compression of the nerve. " The diseased leg was 
moved as if being thrown forward by a sudden jerky movement. In this 
action, so to speak automatic, the cannon and digital region were waver- 
ing ; the cord of the bifemoro calcaneus being itself flabby and quivering." 
Backing was almost impossible ; and often in walking, the anterior face ot 
the fetlock rested on the ground. At the autopsy the great sciatic was 
found pressed upon by a melanotic tumor. Moller has mentioned three 
examples of this paralysis, observed in three large dogs. 

It is not always present alone. In the horse it has been seen existing 
with paralysis of the brachial plexus of the same side (Trasbot) or of the 
opposite leg (Moller, Fries). 

Under the title oi paralysis of the tiiial nerve, some German authors, 
Moller among them, describe the paralysis of the great sciatic, below the 
lower third of the femur. At rest, in standing, the hock flexes, the leg 
drops. During exercise, all the joints flex abnormally, the foot is carried 
upwards as in springhalt ; trotting is impossible. 

The treatment varies with the cause of the trouble. If the nerve is 
compressed by a tumor, extirpation of the growth alone is indicated. 
Against paralysis with unknown causes, bHsterings and iodide of potassium 
should be tried first. Later, massage or faradization of the atrophied 
muscles and exercise are indicated. 

VII. — External Sciatic Popliteal. 

The small fe7noro popliteal or external sciatic popliteal rises from the 
sciatic on a level with the gemelli of the pelvis and runs from backwards 
forwards, from upwards downwards, towards the external face of the 
superior extremity of the tibia, where it terminates by two branches : the 
miisculo-ciitaneoiis and the anterior tibial neji'c. The first ramifies in the 
lateral extensor of the phalanges and the skin. The second, the most 
important, goes to the anterior extensor of the phalanges and to the 
flexor metatarsi. It is exposed to injuries principally at its passage on the 
tibia. 



PARALYSIS. 



411 



Paralysis of the external sciatic popliteal gives rise to symptoms, well 
■described by Goubaux. At rest, either the digital regions are flexed and 
the fetlock rests on the ground, or the foot stands firmly and nothing in 
the attitude of the leg indicates a nervous lesion (fig. 96). In walking, 
the execution of the movements is regular in the upper segments of the 
leg and the extent of the step is normal, but the extension of the 
phalanges being impossible, the toe drags on the ground and sometimes 
seems deviated inwards. At the moment of putting the foot on the 
ground, the standing takes place normally or the digital region is flexed 
on the cannon, and its anterior face as well as the fetlock rests on the 




Fig. 96. — Paralysis of the external popliteal sciatic nerve. (From a photograph.) 

ground ; in this way the tibio-metatarsal angle is open to extreme, the leg 
and cannon are in the same straight line. Flexion of the digital regions is 
often frequent during backing. If the paralysis lasts, and the subject is 
kept exercised, the wall is much worn at the toe. 

In a horse affected with this akinesia, after a violent contusion, 
Goubaux vainly tried blistering and cantherided pitch plasters on the course 
of the nerve. The case of Bouley in his first observation recovered by re- 
peated applications of charge of Lebas. We had only one case of this 
nature to treat ; he got well in three weeks by a single blister on the 
leg and exercise. 



CHAPTER XI. > 
BONES. 

I. 

CONTUSIONS. 

Contusions of bones are quite frequent in horses. Depending on various 
conditions (situation of the bone, thickness of the tissues which protect 
it), its gravity varies principally in proportion to the violence of the shock. 
At times the lesions are Hmited to the periosteum (undermining and sub- 
periostic bloody extravasation) ; at others, the bony tissue is the seat of 
numerous hemorrhagic centers and of crushing inwards if the trauma has 
taken place on an epiphysis ; the marrow itself may be the seat of a true 
bloody infiltration ; and again the contusion upon one face of the bone 
may produce in some cases a chipping off or a fissure of the opposite 
face. The traumatic center not communicating with the exterior, the 
interested tissues are in favorable condition for cicatrization ; oftener, 
exudates resorb regularly; after two or three weeks there remains noth- 
ing of those alterations. 

For slight contusions which have been received on an exposed or 
badly protected bone, the animal should be left some time at rest. 
Douches or slight revulsive frictions (camphorated alcohol, charge of 
Lebas) favor the repair. With severe contusion, a severe lameness is mani- 
fested immediately, or in the following few days ; an oedemaious swelling 
appears, which may involve the bony structure ; there may occur high febrile 
reaction. Often it is difficult to say if there is a simple contusion or a 
split of the bone. Experience for many years has taught that these 
traumas are frequently complicated with fractures ; and it is not ordinarily 
in the first days that they occur, but only after several weeks, when 
rarefying osteitis has diminished the resistance of the bone ; these fractures 
then have for determining cause either muscular contraction while at work, 
or some effort made by the animal, specially in getting up. Therefore, rest 
is again the first indication of treatment for violent contusions of the various 
Lony levers. It is prudent, in serious cases, to place the animal in slings, 
to avoid his lying down and the efforts necessary to get up. The in- 
flammatory phenomena may be treated with cold applications (douches^ 
412 



WOUNDS. 415 

■white lotion compresses, alum water) ; but generally a blistering preparation 
is applied over the seat of the injury and extending some distance round it. 
This has several advantages ; it hastens the steps of the bony inflammation, 
and by the pains it gives rise to, it insures the immobility of the leg ; 
besides deciding the owner to grant his horse a iiseful rest in seeing the 
swelling and the effects produced by the blister. After ten or twelve days, if 
lameness remains, the blister is renewed. Return to work ought not to 
take place before five or six weeks after the accident, when, by the 
repairing osteitis, the bone has recuperated part of its solidity. Often, at a 
later epoch, a diffused exostosis develops at the point of the contusion ; 
if it reaches large dimensions or produces lameness, alterative applica- 
tions (red ointment, bichromate of potass ointment) or cauterization are 
indicated. 

II. 

WOUNDS. 

In pricks, generally the point lacerates the periosteum, slides over the 
surface of the bone or breaks off ; the spongy tissue may be penetrated 
quite deep. Sharp instruments injure bones in various thickness ; in 
small animals, the section is sometimes complete, there is a true fracture. 
Bruised wotmds (kicks, crushings) are the most frequent. 

Made aseptic, bony wounds repair regularly ; even when the perios- 
teum has been largely involved, the bone becomes covered with granu- 
lations, there is not the slightest formation of necrosis. Minute dis- 
infection is then essential. Sublimate ( i p. 1000), phenic acid or cresyl 
(4-5 p. 100) used in irrigations, baths or sprays, clean the traumatic 
center ; wadded dressing, phenicated or iodoformed vaseline, then pro- 
tect the tissues against external germs. 

If the wound suppurates, sometimes the pus collects between the 
periosteum and the bone (sub-periostic abscess of Chassaignac), or the 
periosteum is destroyed upon a wide surface. Free incisions, drainage, 
washings, will prevent the retention of the jdus, its putrefying in the 
bottom of wounds, and will protect against serious alterations. A superficial 
and limited necrosis does not constitute a great complication : the work 
of elimination goes ordinarily in a regular way and the wound, once 
free of the foreign body, is soon filled by granulations. (See Necrosis.) 
Suppurative traumatic osteo-myelitis gives rise to a large swelling of the 
region and to high febrile reaction. It may rapidly extend to the totality 
of the bone, and become complicated with septicemia or purulent 
infection. (See Caries.) 

In the treatment of contused wounds of bones, as in that of contusions. 



414 VETERINARY SURGICAL THERAPEUTICS. 

one must count with the rarefaction, the fragility of the injured organ. 
Long rest and sometimes the use of sUngs are indispensable to prevent 
consecutive fractures. 

III. 

FRACTURES. 

Solutions of continuity of bones have extremely varying characters, 
which have permitted numerous divisions of their lesions. From the thera- 
peutic point of view, it is specially important to recognize : ist, incomplete 
fractures, in which only a part of the thickness of the bone is involved, 
and complete fractures, in which the dieresis is complete; 2d, close f 7-ac- 
/z^r^j without solutions of continuity of the soft tissues surrounding the 
traumatic center; and 3d, open fractures, with wound, exposing this center 
to infectious complications. 

A. — Incomplete Fractures. 

Among incomplete fractures are counted : flexures, or bendings, partial, 
fractures, fissures and interperios teal fractures. In (^^//^//Vz^j-, specially fre- 
quent in yoimg animals, there is either no solution of continuity of the 
bone, or it is injured m part of its continuity, " as happens in green 
wood, which on being bent breaks only on the convexity of the bend- 
ing, and remams continued in the concavity, where stretching of the 
fibres has been less" (Bouley). Partial fractures or with splinters 
are characterized by the separation, from the body of the bone, of a 
piece more or less voluminous. To this are added the driving-in, the 
furrows or perforation made by projectiles. Most generally incomplete 
fractures are constituted by transversal, longitudinal or oblique fissures. 
The tibia, radius, metacarpus are, on account of their being subcutaneous, 
the most frequently injured. Whenever a violent traumatism has been 
applied upon a subcutaneous bony surface, a split must always be feared 
and treated as if it existed. The swelling of the region and the excessive 
lameness imply always serious lesions, exposing to complete fracture. As 
we have said, with rare exceptions, it is not in the first days that it takes 
place ; the pain prevents the animal from resting on his leg or making 
any efforts, and the bone has not yet undergone the changes resulting 
from its inflammation. The fracture occurs most generally after several 
weeks or in the course of the second month following the accident. 
In a case related by Bouley, the tibia broke two months after the injury. 
In a horse treated by us for a contused wound of the internal face of the 
leg, returned to his work a month after the accident, the tibia broke five days 
later, while the animal was working. Another subject, a stallion, received 



FRACTURES. 415 

a kick on the upper third of the internal face of the forearm ; he was, 
against our advice, taken home after twenty-two days. He had scarcely- 
passed the door of the hospital, when, srnelling a mare, he reared and fell 
on the lame leg ; a crack was heard, the radius was broken at the place 
of the first injury. The horse recorded by Vitry had, six months before, 
received a shot on the night anterior cannon, the fracture taking place while 
walking ; the lameness of the first injury had disappeared five months 
before. 

Absolute rest constitutes the primordial indication of the treatment of 
incomplete fractures. The patient should be kept in the stable, tied up 
to prevent his lying down, or better, put in slings. It seems to us that 
Liard and Relier have exaggerated the inconvenience of the latter. Truly, 
some horses object to slings, but in the majority of cases, when they are 
well applied, that the animal is not raised from the ground, he can rest com^ 
.fortably, specially if with them he has a good bed on the floor. If the 
other legs swell, cold lotions, massage, bandages should be applied on them. 
On the seat of the trauma, cold water and astringent lotions are recom- 
mended. Application of a large blister is preferable. In large animals, 
bandages are little used. After six weeks or two months, the animal is 
returned to work, light at first. With time, the exostosis which has devel- 
oped subsides gradually; alteratives and needle firing will promote its 
resolution. In small animals, a diagnosticated split should be treated as 
a complete fracture. 

B. — Complete Fractures. 

Most commonly the result of external violence (traumatism, blows, falls, 
projectiles) or of muscular contraction, complete fractures, in all species, 
are peculiarly frequent on bones of the extremities. They are favored 
by local and general causes. Local inflammatory processes (osteitis, 
necrosis, caries), in reducing the resistance of bones, predispose to secondary 
fractures, which occur easily under the action of some occasional cause. 
The situation of some bones (radius, tibia, metacarpals, first phalanx) 
exposes them most particularly to traumatisms. Some general morbid 
conditions (osteoclasty, osteoporosis) modify the constitution of the bony 
tissue and reduce its resistance. Ordinarily, the lesions due to these 
morbid states are apparent in examining the fractured bone ; there are 
cases where they escape the simple naked eye inspection. Advanced 
age is also accompanied with rarefaction of the bony tissue. In some 
families of animals, a special fragility of bones has been observed and with 
it numerous fractures on one subject, without discovering at the post- 
mortem any manifest alteration of the bony tissue (Stockfleth, DieckerhofT). 
The relative frequency of fractures of the various bones of legs differs -. 



4l6 VETERINARY SURGICAL THERAPEUTICS. 

with the animal species and the service to which they are used. Accord- 
ing to some authors, in the horse, fractures of the superior bones are more 
frequent than those of phalanges. Verlinde, in 42 cases of fractures 
observed in a regiment of Belgian cavalry, during 12 years, 
found only i of the coronet, i of the ossa suffraginis, i of the navicular 
bone, while in 21 cases the femur was the seat of the lesions. Out 
of 159 cases of fractures of the extremities we have found : 5 cases of 
the scapulum, 13 of the humerus, 17 of the radius, 6 of the cubitus, 
3 of the carpal bone, 30 of the pelvis, 6 of the femur, 32 of the tibia, 
I of the OS calcis, i of the astragalus, 15 of the cannon, 24 of the first 
phalanx, 4 of the second, 2 of the third. 

As soon as a fracture is suspected, the diseased leg must be handled and 
manipulated with care. To discover the " abnormal motility " or " the 
crepitation," extensive movements of the bony levers should be avoided, 
as they give rise to acute pains, sometimes to lacerations of the peri-bony 
tissues and of the skin, or to contractions followed by irreducible fragment- 
ary displacements, or again to vascular or nervous injuries. The examina- 
tion must be quick, complete, methodic and made with care. The 
deformity of the region, functional impotency, abnormal mobility, crepita- 
tion, acute pains, impose a diagnosis. Even in the absence of one or 
several of these symptoms, it can be made by the careful examination of 
the region. With fractures of the leg, it is often made by a glance. But 
with thick fleshy masses, as those of the arm or thigh, the diagnosis is 
more difficult, on account of their thickness, which interferes with the 
discovery of the essential symptoms. In the diagnosis of fractures of the 
pelvis, rectal exploration is rarely doubtful. 

Let us recall the possible mistake that can be made of some fractures with 
contusion, tendinous rupture, a sprain, a paralysis. But, in general, the 
differential diagnosis is posed as follows : Is there a fracture or a dislocation ? 
Methodic exploration of the wounded part, the location of the apophysis 
and the mobility, generally allow the solving of the problem. Abnormal 
mobility of fractures has a special character ; it takes place in all direc- 
tions and ordinarily is about as much accused whether the lower part of 
the leg is carried in flexion or extension, abduction or adduction. That 
of luxations is more limited ; abnormal movements are produced more or 
less marked in a given direction, they are impossible in others ; and agaia 
the leg left to itself is stiff, longer or shorter. When in fractures, reduc- 
tion is not kept up, the deformity returns at once. In luxations, if it is 
more difficult, it is generally lasting. 

There is a great, a very great, difference between the importance offered 
in the treatment of fractures in veterinary and human surgery. For our 
large animals, the preservation of life is not sufficient ; with few excep- 



FRACTURES. 417 

tions a recovery perfect enough to permit the return of the freedom of 
motion and work is essential ; and on the other side, treatment is often 
difficult, on account of their indocility and of the numerous difficulties 
one has to overcome to keep the fragments of bones in place. For 
these reasons, animals that have received severe injuries are generally- 
destroyed. It is not because the repairing process is insufficient ; with 
animals, the bony tissue has the same structure and behaves in repairs the 
same way as that of man does. The old belief that bones of animals did 
not unite is dead long ago. But the duration and the expense of the 
treatment, its imperfect result, the remaining lameness when it is a bone 
of an extremity, frequently are objections which command the destroying 
of the patient. Numerous cases exist where the interference of the 
veterinarian is limited to the making of a correct diagnosis. There are 
some cases, however, where treatment must be attempted, even in large 
species ; it is when the regularity of locomotion is not indispensable to the 
usefulness of the animal (milking females, stallions, brood mares). Some 
conditions, favorable to the rapid and regular repair of fractures, must also 
be taken into consideration, such as the youth of the animal, its small 
weight, docility, the small displacement of the bony fragments, or the 
absence of wounds. Yet, let us repeat that it is a rule to destroy all sub- 
jects of little value. 

Such is not the case with small animals. For dogs specially, treat- 
ment we always attempt. It is easy, success is almost sure and many 
owners do not hesitate on account of expense. Ankylosis, deformities, 
permanent lameness, even amputation must not stop us. The preserva- 
tion of life is all that is wished for. 

Once treatment is decided upon, if the patient is not near the house 
■where he is to be kept, he must be carried there without aggravating 
the trouble. The fractured leg should not be left to itself ; it ought to be 
secured at once, even by a temporary dressing. For dogs, oakum, some 
linen, wooden splints, bandages are sufficient. For large animals, 
■walking should be avoided ; extensive movements of the lower ex- 
tremity of the leg promote useless pains and serious disorders at the 
fractured center ; the bony ends may injure the skin, break it and trans- 
form a closed into an open fracture. The injured region should be 
enveloped with linen rags, a sheet, a thick pad of oakum ; it should be im- 
mobilized with splints and bandages, and the patient placed in a wagon. 
The ambulance found in some large cities is very useful. In both the 
animal is kept in the standing position and secured so that he cannot lie 
down. Great care must be exercised when the animal is taken from those 
Tehicles as well as when he is made to enter them, so as to avoid all 
struggles, mis-steps or falls by which the injury of the leg might suffer. 



41 8 VETERINARY SURGICAL THERAPEUTICS. 

In some cases, if there is np displacement, the bone has kept its 
form, direction and normal length, the application of the contentive dress- 
ing may be made at once. But these cases are rare : ordinarily it is 
necessary to modify the position of the fragments. With certain fractures, 
where the displacement has taken place m the thickness of the bone, re- 
duction is made with the animal standing ; by pressures made upon one 
end, while the other is held firm, the normal relations are reestablished. If 
displacement is more marked, if it necessitates difficult manipulations, it. 
is prudent, after the application of a temporary bandage, to cast the 
animal. The muzzled dog should be kept on a horizontal table. 

Reduction is simple if the ends are angular ; it is more complicated if 
tliey are displaced in their length, overlap each other; then, there is- 
shortening of the leg, which is kept up and supported by muscular 
contraction. 

The manipulations of reduction include: i. Extension; 2, coimter- 
exte?ision ; 3, coaptation'. Extension is applied on the lower fragment,, 
counter-extension on the upper, while at the same time both ends are put 
in coaptation. 

With small animals, most ordinarily the hands are sufficient to restore the- 
muscles to their primitive length. Let us suppose a fracture of the fore- 
arm. The operator takes hold of the upper fragment with one hand, and 
of the lower with the other, and by opposite pullings replaces the bone in 
its normal length. If the dog is of large size, an assistant ,may be neces- 
sary to apply the counter-extension. 

The reduction is more difficult in large animals, where muscular power is 
such that it resists the combined action of several aids. The subject cast 
on the side opposite to the fracture, has ropes secured on the upper seg- 
ments of the leg and attached to the wall or to rings fixed on post ; these 
are the mechanical agents of coiaiter-extension. Other ropes are fixed 
round the coronet, the cannon or the lower extremity of the radius, always 
as near the seat of the fracture as possible, avoiding to squeeze the peri- 
fractured tissues ; those are held by assistants, who apply the extension 
with slow, continued, regular pulling made in the direction of the axis of 
the leg. Manual tractions of several assistants are difficult to regulate ; 
they are made by jerks, and often give only imperfect results. Tackle 
and pulleys work more regularly. Coaptation is the more delicate part of 
the operation. When thick layers of muscles cover the bone (thigh, arm) 
the ends of the bone are difficult to make out ; if everything seems about, 
in place, precision is difficult, and yet on this part of the operation 
depends the complete success or the defective recovery of the fracture. 
For members, the mode of displacement of the lower fragment may be 
indicated by the position of the foot, the direction of the toe ; these must: 



FRACTURES. 419 

"be taken into consideration. Fragments badly brought together unite, but 
the callus is voluminous, irregular, the leg is shorter, deviated ; a perman- 
ent lameness is the result. It is specially with heavy and strongly muscular 
animals that it is difficult to obtain perfect juxtaposition of the fractured 
ends. Splinters, interposed muscular fragments, a great obliquity of the 
opposed bony surfaces are as many causes which render the work of co- 
aptation difficult. For the olecranon, the external angle of the hip, the 
point of the ischium, muscular contraction keeps the fragments apart and 
renders their coaptation impossible. 

In some cases, muscles, spasmodically contracted, resist so much more 
that they are more pulled upon ; traction awakes contraction. To relieve 
these " muscular rebellions," anesthesia must be resorted to. With dogs 
an injection of morphine given first is advantageous : it throws the organism 
into a state of torpor faciliating the effect of anesthesic vapors ; it reduces 
to almost nothing the period of excitement ; by it, violent movements 
likely to complicate fracture have been avoided, while they generally occur 
if anesthetic inhalations are used alone. With large animals chloroform- 
ization or mixed anesthesia should be resorted to, carefully holding the ends 
of the bone close together during the period of excitement. Muscular 
relaxation obtained, the fracture is reduced, the ends coaptated and the 
immovable bandage applied. It is advantageous to continue the adminis- 
tration of the anesthetic until the apparatus is well settled and can resist 
the efforts of the animals and of the muscular contraction. 

Must we in all cases of fractures apply immediately the manipulations of 
reduction? If there exists a large bloody effusion, a big inflammatory 
swelling, is it not better to wait until after the diminution of the swelling? 
In man, Dupuytren and Velpeau have said that reduction must be im- 
mediate, in whatever condition the fractured center is. If, as much as 
possible, one must act before the period of inflammatory phenomena, one 
must avoid acting harshly on an inflamed fracture, compress it, or 
twist it, as phlegmonous or gangrenous accidents might follow. The 
bony fragments are surrounded by the exudate, the clots of blood ; the 
hand cannot detect them well, they are not felt, and coaptation is only 
imperfect. Malgaigne has shown the enormous resistance offered by 
inflamed muscles, in the reduction of fractures. A weight of one 
kilogramme, attached to the paw of a rabbit whose thigh was fractured, 
produced, the very day of the accident, only one centimeter of elongation ; 
two days later a weight of three kilogrammes gave only one of 5 mili_ 
meters. In another rabbit, suffering with fracture of the tibia, the over- 
lapping, which was of two centimeters, was overcome the first day with the 
simple weight of 125 grammes; two days later, one of 5 kilogrammes 
elongated the leg only one centimeter and half. The twelfth day, 9 kilo- 



420 VETERINARY SURGICAL THERAPEUTICS. 

grammes gave only an elongation of 5 millimeters; 25 kilogrammes did 
not give any more, and the tibia broke under the weight. One can 
judge by those data of the effort demanded, if in place of a rabbit, it was 
applied on a horse or on a steeer ! 

Reduction, then, should be applied in the shortest time possible, 'before 
the inflammation has invaded the peri-fractured tissues ; however, if in- 
flammatory phenomena exist, it is better to wait for their attenuation. 
Such are the indications derived from the above considerations. 

The bony fragments in good position, they must be kept in it. The 
internal skeleton being wanting, a temporary external one must be supplied. 
Let us consider the means of contention : 

In animals, specially the large ones, perfect immobilization of the center 
of the fracture is not an easy matter. The difficulties are so much greater 
that the patients are more rebel and heavier. The horse cannot stand 
on three legs for a long while ; continually he tries to rest on the injured 
extremity. And if the dog keeps quite willingly the decubital position, if 
with him the dressing is easy to apply, it is rare if he does not try to get 
rid of it. 

There are two kinds of dressings : the movable or immovable. The 
first may be changed frequently ; no hardening substances unite the 
various parts composing it (oakum, splints, rollers). The immovable 
must remain in place until recovery is completed ; an agglutinative substance 
makes all the various consecutive pieces adhere together. These dressings 
are most used in our surgery ; more solid, firmer than the others, they 
offer more resistance to the teeth of dogs, and constitute an envelope of 
excessive hardness, likely to take the place of the fractured bony lever. 

The substances used to make these bandages are : oakum, wadding, 
rollers and a great number of hardening substances or preparations. 

In general, the region is first covered with a layer of oakum, filling up 
hollows and forming a pad to protect the skin from the pressure of splints. 
These are most ordinarily little thin boards of wood, that can be had any- 
where ; those of metallic wire netting have the advantages of being light and 
easily adapted to the region ; molds of zinc, gutta-percha, felt, paste- 
board are also used. This last is very useful in canine surgery ; it is cut 
in strips, having the form, the length and the width of the leg. In large 
animals, a greater resistance being necessary, more solid pieces of wood 
or iron are used. Splints must be made not only to cover the fractured 
bone, but also those that are contiguous to it ; they must immobilize com- 
pletely the articulations to which the fractured bone cooperated to form 
above or below ; in dogs it is proper to envelop the entire extremity down 
to the paw. The number of splints varies : for small animals two are 
generally enough \ three or even four may be necessary for large species. 



FRACTURES. 42I 

The ordinary roller is that used most generally ; bands cut from old 
sheets and sewed together answer the same purpose. 

We have but one word to say in relation to the movable dressings. 
In them, the leg being enveloped with oakum or wadding, and the splints 
-well in place, the rolled bandage is applied all round from below upwards. 
The Sciiltet differs from this, in having, instead of a single roller, a series 
of separate bands, which are secured by pin or stitches of suture. This 
permits the exposure of any one part of the dressing alone, without distur- 
bance of the whole. 

When a solid, permanent dressing is intended, it is necessary to unite 
its various constituents together and with the skin, in using a substance, 
first fluid, but becoming hard, solid by dessication, and able to give to 
the leg a real fixity, to constitute, as IMalgaigne said, an " external skele- 
ton " to replace the internal one, broken in its continuity — it is necessary 
to apply an immovable one. 

Black pitch, which is found everywhere and hardens rapidly, is much 
used in veterinary practice, even for large animals. It is often mixed with. 
turpentine, which renders it more fluid. The first coat applied on the skin 
must be semi-liquid, so as to avoid the formation of scabs its application may 
give rise to. The pitch, having a tendency to soften under the influence of 
heat, must be sprayed several times a day with cold water. Gombault has 
recommended the mixture of equal parts of black pitch and resine. Del- 
wart advocates a preparation made of black pitch 1000, Burgundy pitch 
1000, turpentine of Venise 500. The following mixtures are also recom- 
mended : two parts of resine and one of yellow wax ; five parts of gutta- 
percha and one and one-half of resine. 

The use of guyn arable goes back to the hippocratic epoch. It 
is used dissolved in warm water, or thick syrupous solution. It requires 
six or eight hours to harden. It is softened with tepid water when the 
bandage is to be taken off. In place of gum arable, the mixture of 
Abulcasis is used, or that of glue made with flour, white of eggs and alum. 
Let us again mention the agglutinative preparations of Larrey (white of 
€ggs beaten in water, camphorated spirits and white lotion), that o£ 
Seutin (starch boiled in water), of Velpeau (100 parts of dextrine, 60 of 
camphorated spirits, 50 of hot water), of Lafontaine (warm mixture of 
turnt alum and alcohol). Laugier cut little bands of paper 4 or 5 cen- 
timeters long, covered them with shoe-maker's wax on both faces and 
rolled them round the fractured leg. This mode, undoubtedly simple, 
has the objection of requiring twelve hours to harden. The mixture of 
starch and plaster (Lafargue) hardens quick. 

Introduced in the therapeutics of fractures by the Arabian school, 
plaster was not utilized in Europe until the beginning of this century; 



422 VETERINARY SURGICAL THERAPEUTICS. 

in veterinary practice it was recommended by Bernard, in 1839. First it- 
was used like the moulders do : the leg placed in a grooved splint, thick 
plaster was moulded all round it. The dressing thus obtained was very 
heavy. To Mathysen and Van de Loo is due the credit of the fortunate 
innovation of plastered rollers. To prepare them, bands of tarlatan 
are taken, and on both faces plaster is dusted or rubbed in ; these bands 
are kept in metallic boxes. When they are to be used, they are first 
sprinkled with water, or slightly moistened with wet sponges, and then 
rolled round the region to immobilize, in layers more or less thick accord- 
ing to the mobility of the fractured ends. To-day, bands prepared ad 
hoc are used. Generally simple bands of tarlatan, dipped in paste of plaster, 
are employed. The plaster paste must not be too thick, nor too thin ; it 
is prepared with equal quantities of water and plaster, kept perfectly dry, and 
that has not been exposed to the air. Bands impregnated with this 
paste are rolled round the broken leg : solidification takes place in ten 
minutes ; the dressing is so hard that it resists the most powerful efforts. 
Circular plastering has some objections : it either presses the fracture 
too much or not enough, and does not permit examination of the injured 
region. Actually, in human surgery, plastered splints and gutters are 
used. The splints made of tarlatan, folded in ten, twelve or fifteen 
thickness, are covered with paste of plaster, then spread over the leg or 
the fractured region, without wrinkling, and held in place by assistants; 
the leg is then enrolled with a band which makes the splints adapt them- 
selves well on the irregularities of the leg. When solidification is suffi- 
cient, this band is removed, the various parts of the apparatus are then 
secured by ligatures placed at various parts of its height. In this manner, 
a very firm contentive mould is obtained, which can be applied, closed 
and removed at will. Plastered gutters are cut out on the healthy leg. 
This mode of application is the same as that of splints. 

The bandage of Beelz, excellent for large animals, is made of plastered 
bands, between which are placed coating of lint. In Germany " tripoli " is 
much used ; it is a mixture of plaster, carbonate of lime, of magnesia, 
coal and sand ; this mixture hardens rapidly and forms a mass more solid 
than plaster. (Moller). 

Advantageous as it may be, plaster cannot be of general use. It is not 
as convenient for fractures of the superior parts of the legs ; its want of 
fixity in these cases has been a just reproach to it in those instances. 

For fractures of extremities, Simon recommends gutta-percha applied 
as follows : the reduction made, the fractured region is envolped with a 
pad of wadded peat, then upon that are disposed two gutters of gutta-percha, 
soldered together afterwards with a cultellar iron heated red. So as to avoid 
excoriation of the skin, a pad of wadding should always be placed be- 



FRACTURES. 42$ 

tween the skin and the apparatus.' According to the indications, fenes- 
tra can be made in this apparatus without diminishing its resistance. 
Solidification is quick. To remove the dressing, the envelope is split with 
a knife or with the cautery. 

With silicate of potasse, very firm bandages can be made, but their 
objection is that they take several hours to harden. Bands of linen 
(Fregis) or of paper (Brun) are impregnated with it. Fregis uses it prin- 
cipally for dogs. 

From this rapid consideration of the various bandages we may draw 
the following conclusions : In cases of simple fracture, without inflamma- 
tion or marked swelling, apply immediately an immovable dressing, 
giving preference to those made of plaster, silicate or dextrine. To the 
superior regions of legs, resort to pitch or resinous mixtures, which adhere 
to the skin and do not get loose. If there is marked swelling, acute 
sensibility or considerable oedema, the best is to apply, first the Scullet 
or a wadded bandage, consolidated with splints. After a few days, when 
the inflammatory symptoms are attenuated, apply an immovable dressing. 
If the fractured region was plastered immediately, the bandage would 
have to be changed after a few days, as soon as the leg would be loose in 
the apparatus. 

Adjuvants to bandages. In large animals, bandages, notwithstanding 
their resisting force, might give away under the great weight they have to 
support, when the animal rests upon the fractured leg. Iron supports are 
added to them, the first specimens of which are due to Chabert and 
Bourgelat. Some of those are not without value and do not deserve to be 
put aside as they are in our days. In his Essay Upon Apparatus and 
Bandages (1770), Bourgelat describes iron splints which could yet to-day 
fulfil useful indications. For fractures of the coronet he had a shoe, to 
the heels of which two metallic rods were attached. These were con- 
nected at the base of the fetlock by a concave plate, padded, which sup. 
ported the fetlock. For the fractures of the cannon or of the forearm, a 
rod is started from the toe of the shoe, and run as far as the scapulo humeral 
articulation, which it supports by a widening forming a broad plate. 
Many other apparatus copied on these have since been invented. 

In cases of fractures in large animals, it is important to prevent the 
patient from lying down, efforts to get up being likely to disturb the 

1 For many years we have used gutta-percha, specially for fractures in dogs in general 
and principally those of the extremities. After protecting the skin with a layer of wad- 
ding, the entire extremity or only part of it, as the case required, was enveloped with a 
bandofgutta, softened by dipping it in warm water; when the splints were well adap- 
ted and glued together, it was cooled off with sprinkling cold water over it. This form 
•of splints, besides being firm and easily removed, is very light and can therefore be used 
wth the smallest animals. — A. Liautard. 



424 



VETERINARY SURGICAL THERAPEUTICS. 



apparatus or the juxtaposition of the ends of the bones. To this effect 
sHngs are used. To avoid the fatigue of the superior muscles of the leg, 
which hangs inert and loaded with its bandage, it may be advantageous- 
to have the leg itself placed in suspension, in slings, by having it 
raised ofif the floor in a support of some kind, attached to the ceiling of 
the stall or the ropes of the apparatus of suspension. In digging the floor 
of the stall on a level with the fractured leg or raising the sound ones, all 
possibility of resting on the leg is prevented and the work of repair not 
disturbed. 

Through the Bulletin de la Societe Centrale de Mcdecine Veterinaire 

(1883), Relier has given the description of 
an apparatus, contentive and suspensory, 
which he uses after the application of a 
dressing of circular rolls and agglutinative 
mixture for fractures, complete and incom- 
plete, luxations, serious articular sprains and 
diseases of the feet, where carrying of weight 
is impossible. Relier claims for his ap- 
paratus great superiority over the ordinary 
apparatus of suspension. In connection 
with this let us recall the fact that the 
crutch of Relier's apparatus had already 
been recommended by Lafontaine, who re- 
commended the use of one made of wood, 
to give support to the fractured leg, in- 
stead of placing it in a special sling as Relier 
does. 

Up to recent years, the complete im- 
mobilization of the center of the fracture 
has been considered as the absolute rule. 
All defective, protruding callus, all the 
varieties of pseudo arthrosis were attributed, 
to an insufficient contention. And much 
surprise was expressed when, in 1866,. 
Championnifere came and condemned all old methods, advocating im- 
mediate massage and precocious mobilization, which gives a more rapid 
and sure recovery. 

Immobilization is advantageous ; it permits the regular formation of 
callus and averts the danger of " refractures " which may occur during the 
influence of shocks or of movements of torsion of the leg, when the new 
bony trabeculae have as yet only a slight solidity. But it is not necessary. 
"Who has not seen dogs recover without the least treatment? Do not 




rig. 97. — Apparatus of Relier. 



FRACTURES. 425 

fractures of the ribs unite notwithstanding the continual movements of 
dilatation and depression of the chest? Let us also say that it is not 
without objections. Compressed under a heavy dressing, the leg " breathes 
badly," atrophies, stiffens, ankyloses. To be perfectly curative, the treat- 
ment of fractures ought to reach two ends : immobilize the bony ends 
which are the passive organs of movements, and mobilize the muscles and 
tendons which are its active organs. If there are cases where these two 
conditions cannot exist together, there are some where they do. To this 
point of view, fractures can be divided into two groups : i, those where 
the abnormal mobility of the bony fragments is very limited (some frac- 
tures of the phalanges in horses, of one of the metatarpal or metatarsal 
of dogs) ; 2, those where the disposition of the ends of the fractured bone 
is such that they can readily be displaced and easily overlap each other 
(fractures of the cannon, forearm or chank). 

For the lesions of the first kind, nature has provided for the contention ; 
immovable dressings are not necessary and vascular and nervous com- 
pressions are to be avoided. The complete freedom of the leg, a slight 
massage of the fractured region, some passive movements of the surround- 
ing treatment — that is the rational therapeutics. Scarcely is it worth, to 
please the owner, to place on the diseased surface a wadded dressing with 
the splints and a few turns of loose rollers. After some ten days, the ap- 
paratus will be removed to permit massage and mobilization. In case of 
phalangeal fracture in horse, often some apply only a blister upon the 
coronet. 

But it would be imprudent to treat in the same manner fractures of 
other bones, where the ends are oblique and greatly displaced. Here the 
first and constant indication is to hold solidly the divided parts in their 
normal position, so that the callus shall not have excessive dimensions. 
It must also be acknowledged that the bandage is " analgesical ; numerous 
dogs groan continually before the reduction of their fracture, and stop as 
soon as the bandage is on." 

Cagny has published several results obtained in dogs by the method of 
Championniere. The author does nothing, absolutely nothing ; no mani- 
pulation of reduction, no bandages. The wounded animal is placed in a 
quiet place. He can go about, but everything that might cause him to 
make some sudden movement is avoided. As food he gets meat, bone and 
milk, with a little laxative if there is constipation. Recovery occurs rapidly 
without marked deformity, without lasting kmeness. The Observation IV 
of Cagny shows that the method is not free from reproach. In a grey 
hound that had a fracture of the tibia, and was treated by expectation, 
there was left a very noticeable exostosis, irregularity in motion and a de- 
formity of the leg. We may admit that in this case the owner was to 



426 VETERINARY SURGICAL THERAPEUTICS. 

blame, as " he allowed the dog to run up a stoop of several steps, upon 
which the dog fell repeatedly " ; but we believe that facts of defective 
consolidation and voluminous callus will always be frequent in fractures 
of the legs treated by this " leaving alone " method. Even in dogs, and 
notwithstanding the successes of Ribaud, the process is indicated only in 
fractures of our first group. It is not applicable to large animals ; their 
great weight and the tendency they have to rest on the diseased leg de- 
mand a solid bandage. For fractures of the extremities, except for those 
interesting phalanges, contention must always be energetic and continued 
for four or five weeks in young animals, six weeks to two months in 
adults and old ones. 

In dogs, whenever there is displacement, we apply a dressing, and it is 
only between two weeks or a month after, that, according to the age of 
the subjects and the strength of reunion in the fragments, we begin 
passive motion or allow motion and massage of the region. This latter is 
advantageous ; it " develops muscle," stimulates the circulation, spreads 
out the peri-fractured exudates and favors their absorbtion by lymphatics. 
One of the principal conditions of success, is to know to wait for the 
time where massage is to be used. Complete immobility is in any case very 
difificult to obtain in our animals ; its inconvenience is much less dan- 
gerous than in man. 

The bandage must be carefully watched. An excessive pressure may 
bring on irreparable complications. They are manifested by dulness of 
the patient, loss of appetite, reactive fever. If the dressing leaves the 
inferior part of the leg exposed, the toes are swollen, perhaps oozing 
and covered with blisters. If the apparatus is removed, superficial or 
deep sloughs may be found. In such cases, the injured parts should be 
left exposed for several hours, and washed with phenicated water ; little 
by little the swelling will subside, the circulation is re-established, the 
heat returns ; then another bandage moderately tight is applied. When 
a first dressing has been applied on a tumefied leg, it may happen that 
after a few days it is loose, the leg moves in it. Then it must be changed 
or a certain quantity of mixed plaster be introduced between the old one 
and the skin. 

Notwithstanding the care taken in applying the dressing, if after a certain 
length of time it happens that it is out of good position, it must be removed 
or consolidated. A removal will permit the surgeon to observe the condi- 
tion of the peri-fractured structure and to be assured that the ends of the 
bone have assumed their normal position. 

There is no absolute rule as to the length of time the dressing must 
remain in place ; this varies according to the species of animal, the age 



FRACTURES. 42/ 

•of the subject and the mobility of the fracture. Generally it takes a month 
for small animals, or two for those of large species. 

Some care is required in removing it. When made of pitch, it is 
soaked in water at 45 '' or 50° ; the pitch softens, and the bands can be 
unrolled. This process succeeds also for dextrine or starch splint : the cir- 
cular turns of bands can also be cut with scissors, the splints are easily taken 
off and the pad adhering to the skin is pulled off. Plaster moulds resist 
more, and sometimes have to be broken with a hammer ; plastered rollers 
are cut away with pruning-shears. 

The bandage removed, it can be seen if the fracture is consolidated. 
Evidently one must go very carefully, specially if it is feared that the 
callus is not strong. The animal is afterwards left to himself. The lame- 
ness may not have disappeared entirely, standing on the foot may yet be 
difficult, but by degrees the ttiotions become more free and the circula- 
tion more supple. There are, however, cases where the lameness continues ; 
the callus being large, interferes with an articulation, a nerve or a tendon. 
Fine, deep or penetrant points cauterization is indicated to stimulate the 
partial resorption of the periosteum, or, when the fracture exists on the 
lower part of the extremity, neurotomy, which destroys the morbid sensi- 
bility of the parts. 

We shall be concise in relation to articular fractures and epiphysar 
detachments. 

Open articular fractures are extremely serious : they generally become 
complicated with purulent arthritis. When the fracture is closed, it may con- 
solidate regularly, without complication ; but the repair is generally slow, 
often imperfect, and may be followed with complications : arthritis and 
ankylosis are common; an exuberant callus may prevent all motions in a 
joint. There are cases when there is no work of consolidation. In the 
treatment of these fractures, immobilization must not be kept too long; 
massage should be made early to avoid stiffness and ankylosis of joints. 

Epiphysar detachments occur in young animals. The reduction and 
contention are generally difficult, on account of the small size of the 
epiphysar fragment. The treatment is the same as for fractures in 
general. 

Complications of fractures are numerous. Contusions and bloody ex- 
udation are the obligatory epiphenomena of fractures ; but when they 
are extensive they constitute a special gravity : tissues extensively contused, 
crushed under an intact skin, may later on mortify and transform a 
closed into an open fracture ; a large bloody effusion has a tendency to 
suppurate ; on that account the slightest wounds must be carefully disin- 
fected and the region protected by a wadded dressing moderately com- 
pressive. Wound of an important artery gives rise sometimes to a diffused 



428 VETERINARY SURGICAL THERAPEUTICS. 

l^ematoma, which on feeling gives a pulsating sensation. If collateral cir- 
culation is not formed, gangrene by ischemia is possible. Against this- 
hematoma, wadded pressure of the fractured region £)r ligature at both ends 
after free incision of the tissues, are recommended. Fever is never en- 
tirely absent, but has Httle importance as long as the animal remains gay 
and eating. If the temperature marks or goes beyond 40°, the trauma 
must be carefully watched. Purgatives and diuretics are sufficient to 
overcome a slight fever. Throjubosis, embolies, emphyseina, supe7-ficial 
wounds, diffuse acute inflavi77iation of the. region are again possible com- 
plications of fractures. Gangrene has always a serious prognosis. It may 
follow a severe contusion, arterial lesions, severe inflammation, excessive 
compression. Superficial sloughs should be treated by antiseptics, fenes- 
trated bandages or frequently changed dressing. In dogs, gangrene of 
all the lower part of the leg demands amputation. 

Under the influence of local or general causes, many of which are yet 
badly understood, the callus may take long to form ; the started ossifi- 
cation stops, it seems as if the patient was unable to make bone. To 
those animals, strong food and exercise should be given, the diseased 
regions massaged and douched ; if phosphate of lime and phosphorus are 
not " infallible bone making agents," they possess as much properties as 
tonics do, and are not without being advantageous. Springer, by his 
remarks, has revealed the osteogenous properties of cereals ; these 
should be utilized. At times, callus is not formed between the ends of the 
bone ; these are simply united by fibrous tissue, or again the two surfaces 
become covered with cartilage, surrounded with pseudo-synovial, and a true 
arthrodia is formed. It was said that this was due to the want of 
coaptation and insufficient immobilization ; but the condition of the 
patient and some diathesis play a great part in their development. In 
man, the researches of Cooper, Dupuytren and Tillaux have shown that 
there is almost always the interposition, between the ends of the bone, of 
muscular, tendinous or aponeurotic fragment. When the pseudo-arthrosis 
is finally constituted, in our patients, no further treatment is necessary, 
but in small animals, interference may be called for. First it was tried 
to irritate the two bony fragments : i, by rubbing them against each 
other; 2, by cauterizing the inter-fragmentary fibrous tissue or scarifying 
it subcutaneously ; 3, by passing setons through the false articu- 
lation; 4, by injecting irritating substances in the fractured center. 
Dammann has cured two pseudo-arthrosis of the metacarpals, in the horse, 
by two injections, three days apart, of 6 grammes of a mixture of equal 
parts of lactic acid and distilled water. These methods are to-day 
abandoned. 

Some successes have been obtained by inter-fragmentary galvano-punc- 



FRACTURES. 429 

ture. A steel needle (negative pole) is introduced in the fibrous callus : 
a chamois skin applied on the surrounding cutaneous surface is used as 
positive reophore. 

Another mode consists in starting therapeutic congestion on a level with 
the pseudo-arthrosis. This is obtained by applying a rubber roller, not too 
tight, above the fracture, after this has been consolidated by an immovable 
apparatus. The authors who have employed this method of artificial con- 
gestion claim to have obtained good results ; but it is only successful when 
the inter-fragmentary tissue is fibrous and therefore susceptible to ossifica- 
tion. When the ends are separated by a muscular band, its resection is the 
indication. In man, the bony stumps are made fresh, and then united 
by metallic sutures ; silver thread is the best to use. Aseptic metallic 
plates, screwed on the bony fragments, fulfil the same indication ; but the 
screws which are used to secure them to the pieces of bone may pro- 
duce rarefying-osteitis, and consecutive accidents are to be feared. Quenu 
prefers to them a bony rod, taken from calf, 10 or 12 centimeters long, 
and engaged into the medullary canal of that fractured bone. " How 
does this bone act?" Not only as support, but no doubt in irritating 
the bone and promoting the formation of osteoblasts. 

If the fracture has been badly reduced, if the bony ends are not kept in 
good coaptation, a large callus or a defective direction of the leg may re- 
main. A first indication to recommend is to again break the callus, by a 
sudden action of the hands or with the osteoclast. Antiseptic osteotomy 
ought to be tried. But these serious complications cannot be treated in 
small animals. 

In the same way, if the callus compresses a large nerve and brings on 
paralysis, the patient is generally destroyed, although it has been proved 
in human surgery, that nerves can be isolated from this bony enveloping 
neoplasm. 

Open Fractures. 

Open, complicated ox exposed fractures, are those in which the injured part 
communicates with the outside through a solution of continuity of the 
soft tissues. This solution of continuity may result from the traumatic 
action, cause of the fracture ; it is sometimes made from inwards outwards, 
by a displaced splinter pushed through the skin ; in some cases it is 
consecutive to the elimination of sloughs. With these fractures, many 
variations of ligamentous, bony, muscular and cutaneous lesions are found ; 
in general, they are accompained with extensive lacerations. 

In dogs, crushings by being run over by carriages or tramways make 
very serious lesions ; through the perforated, lacerated skin, the torn 
muscles or tendons, as well as the open articulations, are exposed ; from 



430 VETERINARY SURGICAL THERAPEUTICS. 

the fracture, with its numerous splinters, several fistulous tracts start, and 
the wound is generally soiled with hair, dirt and other foreign substances. 

The infection of a fracture recognizes for cause the introduction, in the 
morbid center of pathogenous elements deposited by the injuring agent 
or the foreign bodies that it carries, the instruments of exploration, the 
fingers of the surgeon, the material of the dressings. To purify the 
wound, is the first indication ; if aseptization is perfect, the fracture 
recovers rapidly ; the callus, first embryonic, becomes rapidly bony with- 
out passing through the cartilaginous stage, as in close fractures. 

The dimensions of the external wound vary very much : sometimes 
very small, it must not be explored, irritated or soiled. An abundant 
and lasting flow of blood makes one fear the communication with the 
center of the fracture. If in doubt, one will act as if the most serious 
lesions existed, the surrounding regions will be shaved, disinfected, and 
the wound freely irrigated with liquor of Van Swieten or strong phenic 
solution and covered with iodoformed collodion, gauze or wadding ; the 
whole followed by immobilization of the leg, as we will show further on. 

If one of the fragments protrudes through the solution of continuity, it 
must be cut off with the saw or sharp shears, specially if the periosteum 
is removed, as its necrosis is necessary fatal. Thorough disinfection as 
above, and then dressing. 

When there is a large wound and with splinters (fractures by wheels of 
carriages, by firearms) the strictest antisepsy is again in order and directs 
the further process of the traumatism. The shallows of the wound should 
be freely enlarged and examined. The extent of the wounds should be 
immediately ascertained and decision taken as to whether it is better to 
treat the wound or amputate the leg (dog) . If the former is decided upon, 
the loose splinter, uncovered of periosteum, should be removed ; condemned 
to die, they would promote suppuration in the wound, be the cause of 
lasting fistulas, and later on impose "necrotomy." The splinters, covered 
with periosteum, protected by an antiseptic dressing, may contribute to 
the repair. If the ends of the bone, which are to unite, are pointed and 
sharp, it is better to enlarge their surface of coaptation by cutting a small 
part of them with the saw or bone nippers. 

These operations ended, the wound is to be cleaned with extreme 
minutiae with strong antiseptic solution. Some bony sutures (silver wire) 
and cutaneous as well (silk) may be applied. After free dusting with 
iodoform and boric acid, the wound is filled with iodoformed gauze, or 
sutured and drained. 

The bandage of ScuUet is the best for complicated fractures : the 
wounded region is covered with wadded pads, immobilized with splints 
and linen rollers. An immovable dressing with dextrine, plaster or gutta- 



FRACTURES. 43 1 

percha is applied, in which, on a level with the trauma, a window is cut 
out, to disinfect it. Movable dressings must be removed quite often, 
guided by the abundance of the secretions of the wound, the temperature 
of the patient, the severity of the pains. That which must be avoided at 
all price, are dififused suppurations, osteomyelitis, purulent infection. 

Prothetical apparatus not being applicable in our surgery, as long as 
a little sensibility and heat of the leg remains, and circulation and in- 
nervation seem preserved, amputation must not be performed, but saving 
of the parts should always be attempted. 

Long antiseptic baths, well carried out dressings will permit, without 
danger to the patient, the elimination of dead tissues and " nature is 
always more saving than the knife." It is thus that we proceed with com- 
plicated fractures of dog. We leave dead tissues eliminate, and are satis- 
fied in avoiding complications by scrupulous antisepsy. We have obtained 
excellent results. Lately, when the amputation at the hock seemed 
necessary, we were able to preserve for a dog the greater portion of its 
metatarsal and phalangeal regions. 

If, however, the bone is much altered, crushed in numerous splinters, 
if arteries and nerves are destroyed, if the wound suppurates and if the 
general condition is serious, it may be necessary, to preserve life, to resort 
to the ablation of the leg. 

The technic of the operation is regulated : After the application of 
rubber garrote, circular incision of the skin on healthy structure, dissection 
of a part of it to cover the stump, amputated a few centimeters above the 
cutaneous incision. The muscles are cut with the bistouri, the bone with 
the saw, the large vessels are ligated with silk or catgut, the skin drawn 
over the stump and sewed. Antiseptic dressing. After a few days, re- 
move the stitches. Generally in three weeks or a month, the cicatrization 
is completed. 

Fractures are frequent in birds, not only in the domestic gallinaceous, but 
also in the other orders. Of all the bones, the humerus, tibia, femur, are 
those on which fractures are most commonly seen ; they are rare in the 
cubitus, radius, ribs or shoulder. 

On account of the presence of air in the hollowed tubes of the long 
bones, traumatic emphysema is often met with, and in cases of open 
fracture, allowing the escape of air, the bird has difficulty in flying, even if 
its wings are free from injury (Richard Owen, Giirlt, Larcher). 

In the thirteenth century, Demetrius published a treatise on the treat- 
ment of fractures of hawks. Dieterichs wrote one on the treatment of these 
in gallinaceous. Often, when the lesion is left to itself, it repairs irregularly 
and leaves a large callus; sometimes, however, when the bird condemns; 
the wounded part to immobility, the consolidation is regular. 



432 VETERINARY SURGICAL THERAPEUTICS. 

Fractures of Extremities. 
/. — Scapula. 

Lying obliquely on the lateral face of the thorax and protected by a 
muscular layer, the scapula is relatively little exposed to fractures. Falls 
and contusions are the most frequent causes. They occur on the acromion, 
one of the superior angles or the body of the bone and most commonly the 
neck. 

Fracture of the acromion is manifested by a circumscribed tumefaction, 
often very painful, situated a little below the middle part of the scapula. 
By the application of a pitch bandage or a blister, it is rare if consolida- 
tion takes place : often the broken portion of the bone necroses and acts 
as foreign body ; an abscess forms after a few days ; punctured, it gives 
escape to a watery pus of bad nature ; the fistula may cicatrize and re- 
appear later on. The observations of Hartenstein have shown the ineffi- 
cacy of caustic injections (Villate solution, tincture of iodine, sulfate of 
zinc), of continued irrigation and of cauterization. Enlarge the wound 
and extract the mortified bony piece are the indications. Antiseptic 
injections insure recovery in a short time. 

\n fracture of one of the superior angles of the bone, there takes place, 
as in most cases of fracture of the olecranon and of the angle of the hip, 
a marked displacement, due to the contraction of the muscles attached 
on those angles. Reduction is impossible, but by blisterings and rest, 
recovery is easily obtained. The fragment becomes fixed in the place it 
has taken, the inflammatory phenomena subside, the lameness disappears. 

More serious are the fractures of the body and of the neck. Most 
ordinarily the bone is divided transversely to its long axis, sometimes 
parallel to it, and then the glenoid cavity is generally involved. The 
prognosis is so much more serious that the fracture is more inferior. 
Pains are less acute and the separation of the ' edges of the fracture 
less accused when the injury involves the body of the bone. Great 
pain, excessive lameness, lancinating sufferings are bad omens. When 
the fracture is comminuted or intra-articular, arthritis ^and purulent 
infection may be looked for ; yet, regular consolidation may occur, as 
shown by the cases of Delaporte and Plouvier. Recovery, however, de- 
mands a long time : often the callus is very large, there is atrophy of the 
muscles and the lameness persists. Godine, Zundel, Schachinger, have 
obtained in horses recovery of the fracture of the neck. We have alsa 
treated with success a large draught horse of six years. Fracture above the 
neck unites easily in cattle. 



FRACTURES. 



433 



" Reduction of fracture of the scapula should be made with the animal 
standing ; the little displacement of the fragments makes it easy ; to do 
it, it suffices to keep the leg in extension and press in, with the hand close, 
the protruding portion of the bone " (Delwart). Contention is not indis- 
pensable (Delaporte and Plouvier). Furlanetto only applied a blister 
upon the shoulder of an eight-months' bull ; the lameness did not disap- 
pear ; the animal was used for breeding. 

To keep the fragments in firm position, various apparatus have been 
recommended. The iron splint of Bourgelat is composed of a metallic 
band thrown over the withers 
and covers both shoulders. 
That which rests upon the 
injured one terminates by a 
plate-enlargement,upon which 
is secured by screws a piece of 
felt, which presses upon the 
center of the fractured region. 
Godine has obtained good 
results with the following : 
After application on the 
shoulder of a mixture of pitch 
and Venice turpentine, wide 
bands are laid from the 
withers, across the shoulder, 
chest, axilla, twisting round 
the elbow, crossing the scapula 
again from downwards up- 
wards to the withers, going 
over the opposite leg and 
enveloping it in the same way, 
to return to the fractured 

shoulder, upon which was laid an emplastic mixture at each passage of the 
band. This was continued until the dressing had acquired a certain 
resistance. 

Delwart, in his method, used bands of linen, three or four fingers wide, which 
he dipped in a mixture of pitch and Venice turpentine. A certain number 
of rolls are placed round the arm and brought back to the superior part 
of the shoulder, crossing each other at the point of fracture. Others, 
starting from the withers, run down the shoulder, surround the shoulder- 
joint and go to be fixed, some on the chest, others on the forearm. 
From the knee upwards, this region is also enveloped by rollers, others 
from downwards upwards : to give more solidity to the dressing, a new- 




Fig. 98. — Bandage for fractures of the scapular, 
and for those of the humerus. (Delwart. 



434 VETERINARY SURGICAL THERAPEUTICS. 

series of bands is applied which starts from the posterior part of the- 
shoulder, and goes to be fixed upon the opposite shoulder after surround- 
ing the chest. A last layer of rollers surrounds the thorax, and reinforces 
the posterior part of the dressing. Although the author advises to have 
the animal in liberty, to allow him to lie down and get up, it is better to 
place him in slings : a greater immobility of the part is obtained, the 
callus is smaller. 

Lafosse has advised the use of a bandage made of a light collar and a 
light saddle, with its sides extended downwards to the back of the elbow. 
The two are united together by straps supporting padding and splints 
covered with stitching mixtures which are laid over the surface of the 
shoulders. 

Once the contention insured, as much as possible, the subject should be 
placed in slings ; if not that, a good soft bed will be given for him to lie 
on. As long as the work of repair lasts, the bandage shall be watched 
and if necessary consolidated with new bands of rollers and pitch. After 
six weeks, the whole thing will be softened with warm water ; for a week 
or two, the region should be massaged, hot lotions should be applied, and 
if the callus is very large cauterization should be resorted to. 

In small animals, when the inertia of the leg, the sensibility of the 
shoulder, the crepitation, indicate fracture of the scapula, the animal is 
cast on the opposite side and the leg is held in extension. The manipula- 
tions for reduction are easy ; in general there is but little displacement. 
Coaptation obtained, an immovable dressing is applied, analogous to that 
used in horses. Bands dipped in- pitch and passed first under the arm 
come across the shoulder • others surround the superior part of the fore- 
arm ; then longer ones are placed which from the withers are fixed down- 
wards on the external surface of the forearm and point of the sternum. A 
few surround the chest as belt ; others, fixed on the base of the neck, 
consolidate the whole apparatus. It is good to wrap up the shoulder, 
thorax and base of the neck with a kind of apron, which prevents the litter 
from sticking to the bandage. The patient is left in liberty. After 
twenty or thirty days the apparatus is taken off ; the callus is suflficiently 
firm. Massage and passive motions will prevent ankylosis and amyotrophy. 
Lameness sometimes remains for months. 

In young dogs, epiphysar detachments of the scapula or humerus are 
observed. Their treatment is that of fractures, but articular lesions are 
likely to complicate the injury and impede the function of the leg. 

Open fractures demand the destroying of large animals. In the smaller 
species, a penetrated immovable bandage or a wadded dressing should be 
applied and the wound treated antiseptically. (See Open Fj-actures). 



FRACTURES. 43$ 



//. — Humerus. 



Fractures of the humerus are ordinarily the resuhs of traumatic actions 
or falls, and sometimes of muscular contractions. Rossignol, Ernes, 
Goubaux, have seen fractures take place while walking without excessive 
effort.^ They are in general twice as frequent on the epiphysis as on the 
body of the bone. Stockfleth has collected nineteen cases of fractures of 
the extremities and only seven of the body. Whether epiphysar or 
diaphysar, recovery is possible, specially in small animals. Stockfleth and 
jMoller have treated successfully dogs affected with bilateral condyloid 
fractures. But prognosis is serious for animals of large species ; though in 
few exceptional cases, where the displacement and mobility of the 
extremities were not excessive, consolidation was obtained (Henon, Cholet, 
Lafosse, Lafontaine, Furlanetto). Lafosse has watched a case which, left 
to himself, was able to resume work in a stage-coach after three months. 
A similar result occurred in a six weeks colt. In the Veterinarian (1855) 
is found the observation of a four-year-old horse which recovered of a 
fracture of the humerus without the application of bandage ; the animal 
was very quiet, the fracture simple and with good adaption of the extrem- 
ities ; the animal was placed in slings ; after three months he walked easily. 

When the ends of the bone remain close to each other, consolidation 
may take place without bandage ; but generally it is an oblique iracture^ 
comminuted ; the fragments overlap, contention is dififlcult. 

Black pitch has often been utilized for the making of bandages in fractures 
of the humerus. They can be alternate with mixture of pitch and oakum 
(Baritaud), or the method of Delwart (See I'racture of the Scapula). 
With this bandage, Furlanetto has cured a steer two years old and several 
young ruminants. He always operated with the animal standing. The 
patients were allowed to lie down and get up during the whole treat- 
ment. 

Lafontaine used a mixture of alcohol (i liter) and crystallized alum 
(500 grammes), which he boiled down to the consistency of syrup; he also 
prepared a mixture of equal parts of rosin and black pitch. Having a nine- 
year-old horse to treat, suffering with fracture of the upper part of the 
humerus, he surrounded the leg with oakum impregnated with the solu- 
tion of alum ; placed two splints, covered with a coat of the mixture of 
rosin and pitch, crossed in X over the fracture, and two others, also covered 
with the same mixture, alongside the leg ; one, the external, extended 
to the withers ; the other, internal, as far as the axilla. Circular bands,. 

^ Burchsted has recorded one case in a fifteen months' bull injured during the act 
of copulation. — American Vet. Review, vol. 22, p. 571. 



436 VETERINARY SURGICAL THERAPEUTICS. 

glued together with the mixture, were applied from the foot upwarcs 
to the shoulder, and passing then over the withers, from the front back- 
wards, and from backward forwards, were at last secured at the point of 
fracture with the adhesive mixture. The animal was left to himself. The 
twenty-fourth day the animal rested on his leg, the apparatus was taken 
oK the forty-sixth day. After two months and a half he resumed his work 
as a cavalry horse. Recovery was perfect. 

Beaufils has described a method of treating fractures of the humerus 
and of the femur, which has given him good results in goats and which he 
believes is applicable to horses. With a long band of linen, he keeps the 
injured leg against the parts contiguous to it. Let us suppose it is a small 
animal which has a fracture of the left humerus. The animal secured in 
the standing position, the operator takes hold, with the right hand, of the 
forearm below the elbow, then with the left hand, raising the arm of the 
animal by its middle, he carries it in an upward motion, so as to bring 
it alongside the corresponding side of the chest, where he holds it. The 
band is rolled a certain number of times round the chest and the arm 
is kept in the new position. To have a solid contention, however, it is 
necessary to involve in the bandaging the elbow, the superior part of the 
forearm and the shoulder ; other circular rolls serve to support the lower 
parts of the leg. Bands with pitch covering the whole, consolidate the 
apparatus. A large sized animal must be placed in slings. 

Tried at the Lyons clinic, it proved successful only in a goat. Dogs 
would not keep it. 

As rightly remarked by Lafosse, fractures of the humerus in small 
animals recover well. The muscles of the arm and shoulder are sufificient 
to hold the fragments in position. With simple fracture, without great 
■displacement, a pitch plaster is advisable. When the more movable ends 
are likely to overlap each other, the bandage of Delwart is recommended 
for fractures of the superior part of the bone ; for those of the lower part 
the method described by Peuch and Toussaint in their Traite de Chinir- 
gie is indicated. It is as follows : The material necessary consists of : 
Fine oakum arranged in small pads, dressing linen or wide bandages, 
a mixture of pitch and turpentine, a solution of dextrine or of silicate of 
soda, and splints, made of pasteboard and cut in the pattern of the leg. 
One of these will be placed on the inner side of the leg and extend from 
the axilla to the foot ; the other, placed on the outside, must reach the 
shoulder joint. All being ready, the dog, muzzled, laid on a table on the 
opposite side to the diseased one, is held quiet. The coaptation obtained, 
to remove all irregularities of surface and give the leg the form of a per- 
fect cylinder, the operator envelops the fractured region and the other parts of 
the leg with oakum dipped in the sticking mixture of pitch or of dextrine. 



FRACTURES. 437 

The splints, also covered with the same, ace placed over the oakum, and 
methodically, from below upwards, the roller is applied from the lower 
■end of the leg, carefully avoiding excessive pressure. A thick coat of 
oakum generally protects agamst gangrenous accidents. 

The application of this roller demands the making of a great many 
*' tenverses" twisting the band on half turn, specially at the elbow, so as 
to insure a close application of the roller, which will be secured to- 
gether by the sticking mixture, to the oakum, to the splints ; or again 
may be sewed up with needles and thread. 

During the first days, the patient must be watched closely. High fever, 
anorexia, groans, indicate too much pressure. The cutting of a few turns 
■of the band permits to examine the condition of the toes, which sometimes 
are greatly tumefied or already covered with blisters, or almost mortified* 
In this semi-sloughing region, the circulation may be restored by sup- 
pression of the bandage. But gangrenous accidents are not much to 
Tdc feared when the apparatus has been properly applied. They occur 
only in cases where the pressure is too great at the seat of the fracture 
and when the bandage does not cover the whole length of the leg. 

This method, so successful with small animals, differs little from that of 
Lafontaine, and it is not surprising if that operator had obtained good 
results with it in horses and ruminants. 

For large species, as soon as the standing is firm, continued, and the 
pulsations of the collateral artery of the cannon are felt, Moller recom- 
mends to leave the animal at liberty. The bandage is kept in place for 
six weeks at least. 

With dogs, it is ordinarily removed after three weeks or a month. Gen- 
erally the bony fragments are then firmly united, and it is rare if another 
bandage has to be applied. During convalescence, douches and massage 
^re indicated. Locomotion is painful for some time, but by degrees re- 
gains its freedom. 

///. — Radius. 

Well separated from the trunk and biit little protected in the greatest 
part of its internal face, the radius is frequently subjected to fractures, 
ordinarily due to traumatisms, falls and sometimes muscular contraction. 
Cases are commonly recorded. Lafosse, Portal, Tassy, Bonnefond, Ros- 
signol, S. Bouley, Degive, Bringard have reported interesting instances.' 

1 Walrath has recorded the case of a performing elephant which after an exercise of 
rope-walking was found lame on the inner foreleg with a fracture of the inner forearm. 
He was destroyed and it was found that the ulna was fractured transversely across 
its lower third and the radius also in several pieces. — Am. Vet. Review, vol. to, p. 
319- 



438 VETERINARY SURGICAL THERAPEUTICS. 

Notwithstanding their serious nature, numerous cases have been fol- 
lowed by recovery. Unfortunately, the uncertainty of the result has- 
decided against the treatment, and animals are often destroyed. 

As for all other fractures of the extremities, the opinion of the practi- 
tioners, in the use of slings, is divided. Some, like Tassy and Portal, 
reject them entirely; they say it is dangerous, tiresome to the pati- 
ents, causing gangrenous accidents and fever, which induce the animals 
to hang in them. Yet most veterinarians continue to employ them. 
It is only in exceptional cases, with very irritable subjects, as the 
stallion " Physician," treated by S. Bouley, that it is better to leave 
them free. 

Therefore, in general, the fracture must be reduced, dressing of con- 
tention applied and the patient slung. If there is overlapping of the 
fragments, he must be cast and placed under anesthesia, being careful, in 
reducing the fracture, to give the foot a good direction. 

With a simple wadded dressing, well applied, Salchow has obtained a 
complete success. Portal has recommended pitch. The coaptation made,, 
the fractured region was coated in its whole extent with liquefied pitch, upon 
■which a thick coat of oakum was laid ; four wooden splints held with turns 
of rollers finished the dressing. With this bandage. Portal has cured a mule 
affected with an open comminuted fracture. After two months, the sub- 
ject was slightly lame ; a points firing was applied over the seat of the 
fracture, the lameness disappeared and the patient resumed work. 

In a horse having a complete fracture of the radius, without displace- 
ment, Tassy enveloped the leg (from the axilla to the middle of the can- 
non) with oakum dipped into a mixture of eggs and burnt alum. Four 
■wooden splints, wrapped up in oakum and covered with Venice turpentine, 
were placed on the four faces of the leg, the external one extending from 
the shoulder to the coronet, and the whole was held in place by turns of 
rollers sewed together. The patient, possessing an extraordinary instinct 
of preservation, would lie down carefully, without putting the slightest 
weight on its fractured leg. After thirty-six days, the apparatus was taken 
off; the callus was very large and made the animal very lame. Firing 
was necessary. ' The lameness disappeared entirely. 

Rossignol, treating a simple fracture of the radius in a four years colt, 
first surrounded the leg with oakum dipped in a mixture of starch, white of 
eggs and powdered alum. Four wooden splints, going not beyond the 
extremities of the forearm, were fixed by turns of a roller, impregnated 
with the same sticking mixture. A wound of the external face of the knee 
■was dressed with tincture of aloes, through a window made in the corre- 
sponding part of the bandage. This dressing was taken off the fortieth 
day ; the callus was very large and the forearm atrophied, but, after a. 



FRACTURDS. 439 

"few months, the muscles regained their ordinary size and the lameness 
disappeared. 

In a horse having an oblique fracture, Dehvart applied a dressing that 
he described as follows : The fracture being reduced, the animal standing, 
wide bands of linen covered with resinous mixture were applied from in- 
wards outwards, upon the fractured spot, and drawn, crossing each other, 
over the external face of the forearm and of the shoulder ; similar bands 
were arranged from the middle of the cannon to the level of the fracture ; 
a pad of oakum laid on the internal face of the olecranon was fixed by two 
long bands crossing each other over the shoulder and secured on the sides 
of the withers and of the neck ; and then a wooden splint, extending 
from the foot to the superior part of the shoulder, was fixed by circular 
turns of a roller. The animal was placed in slings. Four weeks after the 
bandage was taken off; the horse was very lame. Four months later, his 
gait was normal. 

For fractures of the radius, Lafontaine has advocated the same appara- 
tus as the one he used for those of the humerus. 

Already in 1847, Bonnefond recommended the plastered bandage. On 
a fifteen-year-old mule suffering with an oblique fracture of the radius, he 
rolled round the broken region long pads dipped in diluted plaster, upon 
which he applied splints, also plastered, and kept in place by bands of the 
same nature. After two months the apparatus was removed, the patient 
left loose in a spacious place ; he stood well on his foot, there was no de- 
viation in the leg. A horse treated the same way returned to work after 
three months, notwithstanding a slight deviation of the leg inwards. 
MoUer recommended a plastered bandage from the knee to the olecranon.' 

Although serious, the prognosis of radial fracture is not necessarily fatal. 
Lafore and Lafosse have obtained the recovery of an oblique fracture of 
the radius, involving the radio-carpal joint. 

If the fracture is open, fenestrated bandages permit the attendance and 
care' of the wound, which at the same time they immobilize. Bringard 
has cured a mare suffering with an open fracture of the radius, with 
arthritis of the knee. The bandage being applied with mixture of Piau, 
the articular lesions were treated with ordinary means (sublimate 2 p. 
1000, nitrate of silver, segyptiacum.) 

In small animals, complications must not prevent the practitioner from 

1 In a case of compound fracture of the radius in a two-year-old filly, McLean per- 
formed the amputation and the animal recovered. — Amer. Vet. Review, Vol. 12, p. 
371- 

In the case of Adair, the mare, fifteen years old, was pregnant by a very valuable fast 
stallion. She had sustained a compound fracture of the left forearm, the bone pro- 
"truding through the side. The leg was amputated and the mare recovered, and gave 
Siirth some two months after to a colt. — Am. Vet. Rev., Vol. 11, p. 547. 



440 VETERINARY SURGICAL THERAPEUTICS. 

attempting the treatment. By immovable dressings and antiseptic wash- 
ings, Degive has obtained the recovery of an open fracture of the fore- 
arm, compUcated with large contused wound, and complete periosteal 
denudation of the broken fragments. In such cases, tepid antiseptic baths 
•are very advantageous. (See Open Fractures^ 

In young dogs, one meets sometimes with fractures of the inferior 
epiphysis of the radius, badly united. It is generally possible to break up 
again, with the hand, the defective callus. Or, again, the fractured centre 
might be exposed, the callus broken, and the fragments replaced in their 
proper straight line, followed by a new dressing. 

IV. — Cubitus. 

In horses, the cubitus is united to the radius in the greatest part of its 
extent, except at its superior extremity, above the elbow joint which 
forms the olecranon. Fractures of this bone frequently occur on a level 
■with the radio-cubital arch, but they may also take place between the 
beak of the olecranon and the superior extremity of the radius ; they are 
transversal or longitudinal. 

When longitudinal or existing at the radio-cubital arch, the pieces of 
"bone are kept in contact by the fibrous apparatus which surrounds 
them. In the observations of Mercurin, Gombault, Watrin and Viard, 
no elevation of the olecranon is mentioned. In the case of Mercurin, 
Avhere it was drawn slightly inwards, no contentive bandage was applied ; 
the animal was only placed in slings, and recovered completely. Per- 
naud only used emollient lotions ; consolidation took place, but after 
several months the horse was still quite lame. Gombault applied a some- 
what complicated bandage. In his Observation IL, he used seven splints 
secured by bands and a mixture of black pitch and rosin ; recovery was 
perfect. A seven-year-old horse (Obs. III.) and a four months colt 
(Obs. IV.) recovered without lameness remaining. Watrin and Viard 
resorted to a bandage with splints, stucked with dextrine and securing 
the elbow, fore-arm and knee. Delwart is sure that fracture of the ole- 
cranon recovers radically in the majority of cases and advises the following 
treatment : when, by extension of the leg, one has succeeded in reducing 
the fracture by carrying the foot backwards, a quite thick pad of oakum 
is applied on the inside of the elbow, to support the olecranon on the 
inside and push it outwards ; this pad, which has been impregnated with 
resinous mixture, is held in place with immovable bandage described for 
fractures of the scapula and humerus. During treatment, the animal may 
remain free, lie down and get up at will, without any inconvenience.' 
1 Delwart— Traite de med. Vet., Vol. i. p. 530. 



FRACTURES. 44I 

If the bony fragments have remained in contact, it is useless to have 
recourse to a bandage as complicated as that of Gombault. With Rey- 
iial, Peuch and Toussaint, we prefer an emplastic bandage. 

Lafosse says : When the fracture is complete, the apophysis is carried 
upwards by the contraction of the olecranon muscles. The coaptation is 
difficult ; too often a fibrous callus forms between the fragments. In such 
cases, the flexion of the forearm makes the inter-fragmentary space " gab ; " 
on the contrary, extension closes it more or less. There is then advantage 
to carry the leg backwards, to extend the leg, as advised by Delwart. 
To insure the coaptation, one must take pattern on the apparatus of 
Malgaigne for fractures of the olecranon in man ; a padded truss, extend- 
ing from the middle of the arm to that of the forearm, should be placed 
in front of the elbow joint and held in position by dextrined or tarred 
Toilers. A slip made on each border of this truss, a little below the joint, 
would permit to secure the turns of rollers, oblique upwards and back- 
wards, and which would press downwards the olecranon fragment. Im- 
mobilization cannot be kept up too long ; ankylosis is as much to be 
feared as the fibrous callus. 

In a cow, Gombault has treated successfully a fracture of the lower 
end of the radius. The bandage in such cases can be made of plaster 
or pitch ; it is sufficient for recovery. 

In swine, dogs and cats, the cubitus is a long bone, distinct from the 
radius ; it may be fractured alone. The contention is insured by the 
radius. Recovery follows always, even without dressing. Nevertheless it 
is better to apply a plastered, dextrined or starched bandage. 

V. — Carpus. 

The serious nature of fractures of the carpus is due to the unavoidable 
complication of arthritis and ankylosis. Fortunately, they are very rare. 
Trelut (1868) related the case of a horse, which, falling heavily after 
■rearing, crushed the bones of the knee. He was killed; 36 fragments of 
bone were counted, the biggest being the size of a pea. 

Causs^ has observed the fracture of the trapezmm, on a horse which 
had made violent efforts to relieve hmiself from a hobble which held him 
attached to the ground. After a few days of unsatisfactory treatment, he 
was destroyed. Fracture of this bone seems to be produced sometimes, 
principally in race-horses, by muscular contraction. It gives rise to severe 
lameness, which diminishes gradually; but a difform callus is formed 
which produces a lameness that sometimes lasts for months. (See 
Splints). 



442 VETERINARY SURGICAL THERAPEUTICS. 

The articulation of the knee playing a primordial part in locomotion of 
•the anterior legs, recovery of its fractures of the bones which compose it 
— except the sus-carpal — is naturally very incomplete ; the treatment to 
advise is only for animals that can be used for breeding purposes. A 
plastered or pitched bandage should be applied. If lameness remains, 
median neurotomy is indicated. The treatment of an open fracture 
demands before all the antisepsy of the fractured center.' 

VI. — CoxaL 

Formed by the union of three bones — ilium, pubis and ischuim — the 
coxal forms in uniting with that of the opposite side, almost the totality 
of the pelvis. Its fractures, ordinarily produced by falls backwards or on 
the sides in large animals, by being run over in dogs, may involve the 
ilium, ischuim, pubis, cotyloid cavity or several of those parts together. 
The two coxals may also be separated from each other at the pubic sym- 
phisis or fractured simultaneously. 

For the generality of cases, the diagnosis is easy, on account of the 
deformation of the croup, the detection of the bony crepitation, a bloody 
extravasation or a callus. Often rectal or vaginal exploration is necessary. 
If lameness is rarely missing at first, it varies very much in its severity. 
When the fracture has taken place forward of the cotyloid cavity, besides 
the lameness there is shortening of the step forward, but the resting of 
the foot is firm ; when, on the contrary, it exists back of the articulation, 
there is specially pain and stiffness in resting ; when it occupies the coty- 
loid cavity itself, pain is very great at rest and the lameness much accused ; 
in fractures of the ischuim, the leg may be carried in abduction, even at 
rest. (Moller). 

The /////;;/ is frequently injured on its antero-external angle, the angle 
of the haunch ; sometimes a single tuberosity is broken off and remains 
attached to the bone ; then the deformity is slight and slightly marked ; 
crepitation is scarcely perceptible. IMore often, the angle of the haunch, 
completely loose, is more or less drawn downwards by the contraction of 
the ilio-patellar and fascia lata muscles. There is no crepitation, but the 
deformity of the region is characteristic: in the "hipped'''' horse, there is 
an irregularity in the width of the hips, disappearance of the angle on the 
corresponding side to the fracture. A hard, resisting mass, formed by 
the loose piece of bone, is felt in the flank. Lameness is more or less 

1 A fracture of the trapezium recovered without lameness or stiffness was recorded 
by Howard (Amer. Vet. Rev., Vol. 15, p. 601). 

An unsuccessful case of comminuted fracture of the os magnum and trapezium 
was recorded by Harrison (Amer. Vet. Rev., Vol. i,p. 492.) 



FRACTURES. 443 

^accused. Coaptation and contention being impossible, permanent de- 
formity of the hip is unavoidable. But all the troubles caused by this 
fracture disappear always without any treatment, when it remains close and 
not exposed to infection. Recovery is assisted by the application of a 
pitch plaster or of a blistering preparation. Ordinarily after three weeks 
or a month, the subject returns to his work. Delamotte has related a 
case of fracture with numerous splints and congestive abscesses. The 
animal died of septicemia.' 

More serious are the fractures of the neck of the ilium. Death may 
occur rapidly from internal lesions produced by the fragments of the bone. 
In the filly of Tombs, which died in three hours, there was laceration of 
the vagina, of the uterus and rupture of the vena cava in front of the 
pelvis. Excessive lameness, of long duration, gradual lowering of the hip 
on the corresponding side, crepitation when the leg rests on the ground, 
such are the principal symptoms of fracture of the neck. Rectal examina- 
tion establishes the diagnosis. 

Treatment is attempted only with costly animals. The animal should 
be left loose in a box or be placed in slings. Blistering applications 
have evidently only a very mediocre efficacy. Long continued rest 
must be depended upon. The callus, often large, deforms the anterior 
diameter of the pelvis and renders females unfit for reproduction. 

The fractures of the cotyloid cavity have for causes falls or slips ; the 
articular surface of the coxal is crushed by the head of the femur. Almost 
always the cotyloid cavity is divided in three parts ; the lines of fractures 
do not seem to correspond to those of the union of the. three bones in 
the cavity (Barrier). There is severe lameness, acute pains, sometimes 
crepitation, even when the leg is not at rest. There is little deformation 
at the hip, outside of a muscular depression. Rectal exploration en- 
lightens the diagnosis ; but this is sometimes very difficult, specially when 
the fracture is recent. At the autopsy of a horse, killed on account of 
incurable lameness of a hind leg, Prietsch found a fracture of the cotyloid 
cavity, which had not been diagnosed during life. Such lesion is fatally 
complicated with arthritis.^ 

'¥\z.c\.\xxt?> oi iht floor of the pelvis take place in the same condition as 

^ In the case of Dr. Kemp, the animal had sustained a fracture of the ex- 
ternal angle of the ilium, but, as demonstrated at the post-mortem, a laceration of the 
ilio muscular artery had occurred, giving rise to fatal hemorrhage. — Am. Vet. Rev., 
vol. 6, page 544. 

2 In the case of Tritschler the horse had reared and fell backwards on the near 
side. While treated, the leg had become shortened, the co.xo femoral joint very prom- 
inent. At the autopsy it was found that the fracture was at the middle of the coxal 
bone, the acetabulum being crushed in several pieces and the femur displaced upwards. 
— Amer. Vet. Review, vol. 12, p. 513. 



444 VETERINARY SURGICAL THERAPEUTICS. 

the preceding ; they generally occupy the obturator foramen. Rey^ 
:Serres, Jouannin and many others have published cases of it. Nocard, 
in the Archives of Alfort (1876), has written an article on them. There is 
no deformation of the croup, but ordinarily the lameness offers special 
characters ; the leg is moved in abduction ; the animal walks as if suffering 
from severe sprains of the loins ; he always has difficulty to get up (Rev). 
Later, there appear amyotrophies of the thigh and hip ; the callus fills the 
obturator foramen, compresses and atrophies the posterior crural nerve, 
which animates the inferior part of the ischio-tibial muscles and also the 
obturator nerve, distributed to the muscles of the internal face of the 
thigh ; the adductors and flexors of the leg are paralyzed, the leg is moved 
in describing a circumference outwards by the exaggerated action of the 
abductors ; the thigh alone flexes, the remainder of the leg follows the 
movement, but is moved without flexion. 

Rectal exammation rarely leaves the diagnosis uncertain. In some 
cases, death is produced by the rupture of the obturator vessels ; in 
others, the atrophic manifestations which we have mentioned prevent re- 
covery. Sometimes the callus diminishes in great proportion the 
diameter of the pelvis, and mares which have been treated cannot be used 
for reproduction. However, recovery is possible, from the fact that the 
fragments are held in place by powerful ligaments and muscular attach- 
ments and have no tendency to displacement. The therapeutics consists 
only in immobilization in the slings. In the case of Levrat, the right 
ischium was fractured near the cotyloid cavity ; after two months the 
mare was able to walk ; a month later she was working on the racing track 
free from lameness ; the following year she was used as a brood mare and 
delivered several colts. 

In case of fracture of the iscJiiaiic tuberosity, the loosened bony piece is 
pulled downwards by the ischio-tibial muscles ; the result is a peculiar 
deformity of the croup : flattening at the height of the ischial tuberosity 
and an abnormal projection on a level with the articulation. In some 
cases this fracture gives rise to a displacement, a " luxation " forward of 
the posterior portion of the long vastus. (See Muscular Luxations^ 

VII. — Femur. 

Frequent in all species, fractures of the femur involve the diaphysis or 
the epiphysis. Many cases are related of compound and comminuted 
fractures of the diaphysis. Greeve has made the autopsy of a cow where 
the femur was crushed in eighty-five pieces. 

Fractures of the neck are quite common. Fromage de Feugre', Rigot, 
Leblanc, Gurlt, Williams, Percivall, Gamgee, Nocard, Pourtanel, have 



FRACTURES. 445 

published many observations. Some cases have also been recorded of 
fractures of the femoral head, of the inferior articular apophysis (Stock- 
fleth, Moller), trochanter, subtrochanterian tuberosit)'.' 

Except in this last instance, whatever is the seat of the fracture, there 
is no economy in trying to treat them in large animals. Reduction is 
difficult, on account of the great muscular force to overcome, and conten- 
tion is nearly impossible. With few exceptions, consolidation cannot take 
place without a large callus, a shortening of the leg or a permanent lame- 
ness. Rey has, however, seen a horse in which a fracture of the femur 
had united spontaneously. Bassini has obtained the recovery of a fracture 
of the neck (?) in a bull ; the thigh was enveloped in a supporting ban- 
dage and the animal left loose. Four months atter the accident, the 
animal stood nearly plumb, and was able to work with its leg in normal 
position.^ 

In small animals, fractures of the femur unite readily. On more than 
20 dogs, Lafosse has always obtained union, with either pitched bandages 
or by only expectation. We have used a bandage of pitch on the hip, 
the external face of the thigh and of the shank, and have obtained a 
recovery in a month. Delwart recommends, when the coaptation is 
once made, to pass under the groin bands which cross each other over 
the thigh and secured on the summit of the croup, while others are fixed 
on the external face of the thigh and leg. 

Beaufils has recommended the same bandage as for fractures of the 
humerus. The animal kept standing, the operator with one hand pushes 
the stifle of the fractured leg toward the flank, while with the other he 
raises the thigh, in order to bring the broken bone parallel to the great 
axis of the body; turns of rollers, starting from the injured thigh, are 
passed all round the body, until it is well immobilized ; then the other 
parts of the leg are flexed and supported with more rollers ; finally, to 
prevent the apparatus from slipping backwards toward the tail, two bands 
covered with pitch are applied over the whole length of the croup. 

Felizet has invented a singular mode of contention. The animal, 
laid on a board covered with straw or hay, is secured with turns of rollers, 
passing several times round the body and the semi-flexed legs, and after- 
wards secured to the board by means of points nailed in the board. A 
dog with fracture of the neck of the femur, treated in this manner, was 
let loose twelve days after " with his femur entirely and regularly con- 
solidated," but a goat and two cows died in a few days. This method 

1 A fracture of the internal lip of the trochlea of the femur is recorded by T. Wal- 
rath in which the bony hard edges of the fractured portion, as well as the base of the 
trochlea, has been removed by absorption. — Amer. Vet. Review, vol. lo, p. 7S. 

2 Furlanetto, Prog. Vet., 1890, p. 362. 



44^ VETERINARY SURGICAL THERAPEUTICS. 

is evidently good only for animals which are not very irritable ; simple 
immovable bandages are preferable. 



VIII.— Patella. 

Lafosse, Renault, Lenck, Goubaux, Andrieu have related interesting 
cases of fractures of the patella. They are due to traumatisms or muscu- 
lar contraction. Lafosse thought that transversal fractures only were pos- 
sible, but the observations of Lenck and Goubaux have proved the exis- 
tence of longitudinal injuries. In both varieties, the accident may be 
simple or complicated ; it is always accompanied with inflammation of 
the femoro-patellar, synovial and sometimes with femoro-tibial arthritis. 
It is on this account that Lafosse, d'Arboral and Goubaux erroneously 
thought that those fractures were incurable. 

In the case of Lenck, the separation of the fractured segments was con- 
siderable. On the pieces that Goubaux dissected, he has never observed 
separation of the fragments. If the fracture is transversal, a piece of the 
bone may be drawn upwards ; but when it is longitudinal the separation 
is ordinarily very small ; the fibrous coverings which are over the an- 
terior face of the patella hold the fragments in place. 

With a closed fracture, pitched immovable bandages, made with bands 
placed above and below the patella, then crossed over the lateral faces of 
the region, or simply repeated blistering applications, are used ; Delwart 
recommends two methods, which proved very good with him ; with one, the 
horse is kept perfectly at rest for fifteen or twenty days, with his leg held 
slightly forward by a rope ; with the other, an immovable bandage is 
applied over the whole region. 

Andrieu has obtained the recovery of an open fracture. Toward the mid- 
dle of the patella, there was a wound allowing the introduction of the finger, 
which could feel the fracture of the bone in three pieces ; this wound 
opened in the patella sheath, and from it synovia escaped. Notwith- 
standing the severity of the lesion, treatment was undertaken with con- 
tinued irrigation. After two weeks, walking exercise was begun; after 
a month all treatment was stopped, and the animal put to light work ; 
a month later there remained but very little lameness in trotting.^ 

With open fracture of the patella, 2i fenestrated hdiW^Q-gQ with frequent 
antiseptic injections m the wound is the treatment to be recommended. 

^ A fracture of the patella is recorded by J. C. Meyer in which ligamentous union had 
taken place between the fragments of the bone, which at the post-mortem had been 
found, the external piece articulated with the external lateral surface of the femur, 
and the internal was resting in the fossa between the trochlea and the inner condyle. 
— American Veterinary Review, Vol. 6, p. 239. 



FRACTURES. 447 

Immobilization should be not carried to extremes ; massage and early 
exercise will prevent articular indurations and muscular atrophy. 

IX. — Tibia and Fibula. 

Fracture of the tibia is one of the most frequently met with. The posi- 
tion of this bone in the skeleton of the hind leg exposes it particularly to 
kicks, principal occasional cause of the accident in horses. It is true that 
this fracture is always serious, but it is not necessarily irremediable, as con- 
sidered by many. Many cases are recorded in our journals. In 1838 
d'Arboral reported those of Tamisier, Duchemin, Geant, Mullon, Bet- 
tinger, Leblanc, in horses ; of Mullon, Buisson, in cattle. The cases of 
Lavigne, Rossignol, Lafontaine, Poisson, have added to the proofs al- 
ready obtained of the possibility of recovery in cases of fractures of the 
tibia in animals. Every practitioner knows of its benignity in dogs. 

The chances of success exist principally when the fracture is located 
in the lower third of the bone, when it is transversal and without dis- 
placement ; fractures of the middle or superior part of the bone, the 
oblique one complicated with overlapping of the ends, are the most 
serious. 

As in most fractures, interference imposes two indications : reduction 
and contention. If possible, reduce in the standing position. If the 
animal has to be cast, use anesthesia. For contention, use pilch, gutta- 
percha, plaster or the mixture of Piau. 

In the horse treated by Bettinger, the middle part of the tibia was 
the seat of an oblique complete fracture. Reduction was made in the 
standing position : a first apparatus made of linen cloth, black pitch 
and rollers having become loose, the author made a kind of corset 
with a double piece of strong linen, between the layers of which sev- 
eral flexible splints were sewed, parallel to the leg and separated more or 
less from each other. This "corset" was padded on its inside and held 
in place by a roller. The bandage remained in place thirty-eight days. 
A chafed wound of the tendo-Achilles healed rapidly ; the gait, stiff first, 
became normal gradually. Later, the callus was fired, and though he was 
a little lame, the horse was able to resume his work. 

Leblanc has treated several fractures of the tibia. To place the horse 
in slings, lower the floor of the stall by a hole under the broken leg, 
make extension with a heavy weight tied to the foot, apply a bandage on 
the leg made of oakum, black pitch and splints, two of which are quite 
long and extending, the external from the foot to the stifle, the internal 
from the hoof to the upper third of the leg ; such is the modus operandi 
he recommends. 



448 VETERINARY SURGICAL THERAPEUTICS. 

With his apparatus (see Fractures of the Humerus), Lafontaine has 
cured a fracture of the tibia in a mare. In the same way, Poisson 
obtained the recovery in a nine months filly. 

Lavigne threw down a young bull that he had to treat. With a rope> 
tied on the thigh, he made counter-extension ; with another fixed to the 
coronet he extended the leg and adapted the fragments together. To 
diminish the action of the muscles, he squeezed the tendo-Achilles on the 
tibia with bands of linen rolled several times round the leg. A piece of 
pasteboard, cut gutter-like, pitch, and splints from the hock to the lower 
end of the thigh, served to form a strong bandage. The patient was left 
loose, free to lie down and get up. After thirty days, the dressing was 
removed, the callus was formed. 

Rossignol has published several cases of recovery of fracture of the tibia 
in swine and sheep. In one, the superior fragment protiuded through the 
skin ; it was amputated ; a fenestrated bandage allowed the dressing of 
the wound with tincture of aloes. Oakum impregnated with a mixture of 
starch, alum and white of eggs, with splints and rollers, made a strong 
supporting apparatus. In the same way, Morin cured a heifer.^ 

According to Delwart, when the fracture is simple and transversal, 
success will always follow the application of an immovable bandage 
extending from the superior part of the fetlock to the patella. The 
bandage is reenforced with two strong splints, one external from the thigh 
to the fetlock, the other internal from the stifle to the same point. L. 
Lafosse has obtained the regular consolidation of a fracture of the tibia in 
a colt, a calf, six pigs, three sheep and a large number of dogs. 

In this last animal, those fractures recover very easily. Two pieces of 
pasteboard, cut in the shape of the leg and extending from the lower end 
of the leg to above the stifle, are applied over a pad of oakum enrolling 
the leg, and kept in place by turns of rollers coated with dextrine, silicate 
of potash or pitch. (See Fractures of the Humerus.) This bandage must 
be left in place from three weeks to a month. If it gets loose or becomes 
displaced, it is consoUdated or replaced by another made in the same 
way. 

With open fractures, the fragments are immobilized with an immovable 
apparatus, placed after careful disinfection and the wound well enveloped 
with wadding ; but as the asepsy of the wound is often insufficient, a 
fenestrated bandage is preferable. 

Fracture of the fibula exists most generally in common with that of the 

1 H. D. Fenimore delivered a calf which had a consolidated fracture of the right 
tibia near the lower third of the bone. The bone was bent a right angle and this de- 
formity was the cause of the distokia of which the mother suffered. — American 
Veter. Review, vol. 21, page 566. 



FRACTURES. 44^ 

tibia. As a distinct lesion it is rare. External violence on the supero- 
€xternal part of the leg may give rise to it ; ordinarily there is no dis- 
placement ; with a simple primitive bandage, consolidation takes place 
rapidly. 

X. — Tarsus. 

Fractures of the os calcis are rare ; they are caused by external violence 
or muscular contractions. Jumps, slips, falls are the ordinary causes. 

In general, their recovery is attempted only in small animals. In the 
large species the treatment demands often more than three months 
(Haase). However, recovery has been obtained in cattle, in a few weeks, 
by an immovable bandage of plaster or pitch and resine (Brauer, Detroye). 
The patient of Detroye — a fifteen months bull — in trying to cover a cow, 
raised himself on his hind legs : a peculiar noise was heard, like " that of a 
dry branch of wood breaking ; " the animal falling suddenly, the os calcis 
was found fractured obliquely in the middle of its height. A strip of 
iron, gutter-like, adapted to the front part of the leg and extending 
from the middle of the leg to that of the cannon, was held in place 
with four straps, two above and two below the hock. Well padded in- 
side, this bandage kept the hock extended and insured the coaptation 
of the bony fragments, thanks to the relaxation of the tendo-Achillis. 
It was removed after three weeks. At first the animal stood hesitatingly, 
"but by degrees it improved and the lameness disappeared, notwithstand- 
ing a permanent deformity of the hock due to the callus. The result is 
not, however, always as satisfactory. A horse and a calf treated by the 
same author had to be destroyed.^ 

Fractures of the astragalus, still rarer than the preceding, is ordinarily 
the result of a sudden rotation of the hind leg on its axis, the foot rest- 
ing on the ground and not obeying the motion started by the superior 
muscles ; the tibia pivots on the astragalus, the median projection of the 
articular surface of the tibia breaks off the tarsal pulley. Moller has 
seen the lesion in a horse making a sudden volt. Furlanetto claims to 
have seen it in a cow that had fallen in a hole ; he applied an immovable 
b)andage reenforced by two wooden splints extending from the middle of 
the tibia to the fetlock; it was removed after thirty-five days. The 
animal remained lame for a year ; there was a callus as big as the two 
iists. 

In general with large animals, and from an economical point of view, 

1 Os calcis. — A case of open fracture of the os calcis without displacement was 
recorded by Harrison in which the treatment was simply keeping the horse in slings 
and local dressing to the wounds. The animal recovered. — Am. Vet. Rev., vol. 5^ 
page 68. 



450 VETERINARY SURGICAL THERAPEUTICS. 

the lesion is incurable. For small animals, a plastered or resinous immov- 
able dressing should be applied. 

Fractures of the other bones of the tarsus are generally observed onljr 
with luxation of the joint, which they sometimes complicate. Rey has 
published a case which occurred in a horse drawing railroad cars : 
the lower end of the scaphoid was fractured, the inferior part of the 
cuboid worn by rubbing, the external metatarsal separated from the prin- 
cipal and fractured in its superior third ; the external ligaments and the 
interosseus were ruptured ; the tendon of the flexor metatarsi was torn at 
the insertion corresponding to the fracture. Such accidents are of the 
most serious nature. Treatment is not attempted. 

XL — Aletacarpiis and Metatarsus. 

Situated at the inferior extremity of the leg and rather unprotected, 
the cannon in our large animals is much exposed to traumatisms of all 
kinds, consequently to fractures ; but its vertical direction and the small 
size of the region favor the chances of the treatment. The fragments, 
specially when the division is oblique, are generally but little displaced, 
and cases of complete recovery are rather numerous. Megnin has 
published the case of a horse, in which union took place without the 
slightest treatment, the bone being only slightly crooked and the callus 
large. Most ordinarily the manipulations of reduction are made standing, 
the fragments of the bone being in contact and the weight of the lower 
one sufficient to hold it in a vertical direction. In a few cases like that 
of Gombault, it is necessary to cast the patient. The deviations of the 
extremity must be avoided ; the toe of the foot in solipeds and the in- 
terdigital space in ruminants will guide the manipulations. 

A number of substances has been used to make bandages. Gerard, 
Conte, Gombault have recommended black pitch. The cannon is sur- 
rounded with oakum impregnated with the sticking preparation, so as to 
give it the size of the articulations which this bone cooperates to form ; 
those joints are also protected with oakum from the pressure of the splints 
and guarded from cutaneous gangrene that might occur; splints, as long 
as the cannon (Gombault) or extending from the knee to the ground, so 
as to assist in the resting of the leg (Conte), are arranged upon that 
oakum and held by turns of pitched rollers. Delsetre has advocated the 
white of eggs, bitten with camphorated alcohol ; Marzac, a bandage made 
of starch, plaster, wire, and oakum ; Rossignol, starch, alum and white of 
eggs ; Stievenaert, the bandage of Delwart, with oakum, pitched rollers 
and splints. 

But, without doubt, plastered dressing holds the first rank. Used first- 



FRACTURES. 451 

"by Bernard, then by Bonnefond, Vidal, Pujos, Bouley, Nocard, Morand, 
Furlanetto, Lucet, it is superior for fractures of the cannon. Pujos sur- 
rounded the leg, from the foot to the middle of the forearm, with bands 

. dipped in wet plaster and rolled from downward upward. He put on three 
coats and thus made a cylindrical muff, sixty centimeters long and thirty-two 
in circumference. Removed forty-five days after, the animal stood firm ; 
and two months after the accident the horse was not lame. Vidal ap- 
plied first, upon the cannon, oakum dipped in a mush of plaster, then 
splints, one on the inside, the other on the outside, extending from the 
knee to the lower part of the fetlock and kept in place by plastered 
bands, and on the top of those a thick layer of plaster ; a month after 
the horse resumed work ; fifteen days later recovery was complete. 
Morand used about the same technic in a fifteen days old colt, suffering 
with fracture of the metatarsus ; he removed the dressing in twenty days ; 
union had taken place. On a twenty months steer, the same author ap- 

. plied a similar bandage, which was taken off after forty days. There re- 
mained a slight lameness, which disappeared later. The observations of 
Lucet and Furlanetto show that after thirty days a firm callus is almost 
always formed, in bovines. Simon has utilized gutta-percha in an eight- 
een-year-old horse. This animal died of colics on the twenty-third day 
of the treatment. At post mortem a temporary callus, very firm, had 
already formed. " Complete recovery, without deformity, would certainly 
have been obtained." 

For colts, Rossignol recommends a very simple bandage which has 
given him numerous successes ; cut a branch of willow, split it in two, 
gauge each half gutter alike and bevel the extremities ; reduce the fracture 
and cover the cannon with a pad of oakum; apply the two wooden splints 
of willow and secure them with three pieces of wire twisted on the out- 
side, one in the middle of the bone, the others at each end. 

After all, fracture of the cannon is one of least gravity. It must be 
treated on animals of great value, specially if they are quiet and of small 
size ; when the patient is light, the iise of slings is not necessary. The 
patients of Gombault, Conte, Delgerte, Morand, Lucet were left loose, 
lying down and getting up without trouble. The slings are advantageous, 
while treating an adult, specially if he is heavy. 

Sometimes, only one of the small metacarpal or metatarsal is broken. 
On a horse, Clichy saw it on the left hind leg. Both ends were in con- 
tact — there was no displacement. Pads of oakum with white of eggs and 
a pitch plaster were applied. After six weeks the animal was cured. 
In the case of Cauvet, the fracture of the external metatarsal of the right 
leg was complicated with that of one of the bone of the back. A suppu- 
rative arthritis killed the patient. 



452 VETERINARY SURGICAL THERAPEUTICS. 

In dogs, the fracture of these bones gets well readily. A bandage left 
on from fifteen days to three weeks insures the union. Many practi- 
tioners employ starched or plastered dressings. 

Compound fractures are treated by temporary antiseptic bandages or a 
fenestrated immovable dressing; 

XII. — Phala iiges. 

Splits and phalangeal fractures are frequent accidents. There are few- 
practitioners that have not seen numerous cases. In 1754, Lafosse, Sr., 
published nine observations of fractures of the second and third phalanges. 
Observation V. relates to a horse which, though having made no effort, 
"fractured in twenty pieces the os coronae, without any injury to the os 
pedis or to the tendons." If traumatisms, jumps, violent strains produce 
them in a certain number of instances, there are cases where fracture 
takes place with a slow gait, after a simple mistep or even without ap- 
parent cause. Reul has related three cases of the coronet, occurring in 
horses in harness, " without fall or slip." We have often seen similar 
cases. But ordinarily, in such circumstances there is a split or a rare- 
faction of the bone. 

"Wit first phala?ix is most frequently affected. Its fractures are trans- 
versal or longitutinal. Transversal, they involve its superior half. 
Tissures or splits start almost always from the median groove of the su- 
perior face (Peters) ; they extend to the lower extremity, or, again, they 
are oblique toward one of its borders ; sometimes they occupy only a 
part of the height of the bone. Fractures are quite often comminuted ; 
in a race horse, Dressier saw the first phalanx broken in nineteen pieces ; 
Bonnard counted as many as thirty-four : " five large ones, five smaller, 
twenty-four very small." Roeder has seen a horse, which in falling 
fractured the first pastern of both fore and of the right hind leg. Wend- 
worth has also seen on a horse the fracture of the first pastern on both, 
forelegs. The fractures of the second pha/anx are sometimes vertical, at 
others comminuted. In this last variety, the number of pieces varies from 
five to ten (Henon, Moller, Schrader). We have stated that Lafosse 
counted as many as twenty pieces. Henon speaks of a horse where it 
was broken in every one of the four feet. In some exceptional cases, the 
posterior border projecting beyond the superior articular surface has been 
found loose from the bone. Bascon and Dumont have seen that lesion, 
on both forelegs. Lafosse, Huzard, Duliege, Adenot, Havemann, Kerst- 
ing, Nocard, Trasbot have related cases of fractures of the third phalanx^ 
Schrader has related cases of it with fractures of the ossified supple- 
mentary cartilage. 



FRACTURES. 453 

The diagnosis of a phalangeal fracture is not always an easy matter. 
.When it is on the first phalanx, severe lameness, pain under manual explora- 
tion, swelling, abnormal mobility, crepitation, will assist in making it. If 
it involves the second phalanx, the hoof may interfere with the detection 
of the pathognomonic signs. The great sensibility to manipulation and 
twisting of the region is not always sufficient for a diagnosis. In the case 
of a fracture of the third phalanx following a deep punctured wound of 
the foot by a nail (Duliege, Trasbot), or after a keraphylocele (Nocard), 
the lesion may be easily made out. If the fracture is due to violent con- 
tusion or to a crushing of the foot, it may be suspected by the severity of 
the lameness and perhaps positively made out, according to the condition 
of the wall, which may be intact, broken through or entirely torn off. 

Is there any advantage to treat phalangeal fractures ? is a question upon 
which opinions differ much. Reul says it is altogether anti-economical 
"to treat accidents of this kind, when they occur in adults or old working 
horses. It is only proper to attempt it in colts or selected breeding 
animals or those of great value." Though this opinion is that of many, 
it seems to us exaggerated. In general, compound comminuted fracture 
should not be treated, specially if the animal is old and of little value ; 
but, on the contrary, one is to interfere in cases of simple fracture upoa 
joung or adult subjects. It is true that union is always accompanied with 
the formation of an enormous callus, which interferes with joints and 
tendons and gives rise to lameness which is rebel to firing and blistering. 
But by neurotomy (plantar, high or double, median or sciatic), the lame- 
ness diminishes very much and the regularity of action may be restored- 
At present, there is in Alfort a thoroughbred which has been neurotomized, 
high and double operation, after a fracture of the first pastern : the result 
has been that for the last six years he does good work. Facts of this 
nature are not uncommon, and on this account we advocate the treat- 
ment of those fractures in a number of cases. 

The tendons and ligaments of the region may be sufficient for perfect 
contention, specially for fractures of the os corona. Recovery demands 
rest, immobilization of the extremity or a blister over the digital region. 
With fractures of the first phalanx, when the fragments have a tendency 
to move upon each other, it is better to have recourse to plaster bandage 
(St. Cyr, Quinn, Rouillart, MoUer). St. Cyr enveloped first the coronet and 
lower half of the cannon with a bandage covered with plaster mush ; over 
this a second band and then a second coat of plaster ; oakum dipped in 
the hardening mixture and a roller applied from downwards upwards com- 
pleted the dressing. The animal was left loose ; two months later union 
was complete ; after three months, he was scarcely lame on walking ; he 
soon resumed work. Quinn, in a fracture of one hind coronet, applied 



454 VETERINARY SURGICAL THERAPEUTICS. 

plastered bands from the hoof to the hock, so as to form an apparatus four 
centhneters thick; after eighteen days the animal rested the foot firmly 
on the ground ; a complete recovery was anticipated, notwithstanding the 
rather exaggerated size of the region. Johne has cured in two months a 
horse with transverse fracture of the first phalanx. Rouillard and many 
others have also obtained good results with plastered bandage. Gayot 
has seen recovery of a transverse fracture of the first phalanx of the right 
foreleg and a longitudinal fracture of the second of the left foreleg. Even 
bilateral phalangeal fractures do not constitute incurable lesions ; still, even 
with the use of slings, recovery is very uncertain. 

If the fracture is comminuted or compound, killing is imposed. Immov- 
able bandages, antiphlogistic and antiseptic, give only half success. 
In presence of a fracture of the second or third phalanx, the veterinarian 
should prescribe antiphlogistics (cold compresses, cold baths, continued 
irrigation) or a blistering application ; a strengthening bandage is not 
necessary. 

In most of cases, as we have already said, union of a phalangeal fracture 
does not take place without the formation of a thick callus, a lingdone, 
"which demands treatment. Blistering and firing are generally little useful. 
When after two or three months the lameness still prevents the animal from 
work, neurotomy is indicated. 

XIII. — Sesamoids. 

Although made of a thick layer of compact tissue, lined up with a 
fibro-cartilaginous padding, the large sesamoids may be fractured. Warnell, 
Salle, Dubos, Williams, Leisering, Rutherford, Schoneck, Moller, Delavenne 
have recorded many cases. In several observations they were animals 
kept for some time at rest on account of lameness ; the accident being 
produced by a mis-step or a slip. Most often, it is during efforts of loco- 
motion, specially jumping, that it occurs (Williams, Warne, Salle). Going 
at a full speed, the horse of Salle struck the left anterior fetlock with the 
liind foot of the same side. Immediately the animal was unable to stand 
on his leg, the bruised part became swollen and " shook loose " in 
walking. At rest the standing was normal. In a similar case, fractures- 
of the large sesamoids were found (Schoneck, Moller, Delavenne). 

Standing is almost impossible when the suspensory ligament is torn from 
its insertion on the sesamoids ; at each step the fetlock drops down close 
to the ground. The perforans tendon may be more or less altered at its- 
passage in the sesamoid groove. Sometimes the bones are broken irt 
several fragments. 

If treatment is attempted, it is better to apply a solid plastered or 



PERIOSTITIS— OSTEITIS— OSTEOMYELITIS. 455 

;gutta- percha bandage. According to the disposition and weight of the 
animal, he will be placed in slings or left loose. The local inflammation 
passed off, if lameness remains, firing or neurotomy (median or sciatic) is 
indicated. When several legs are affected, the patient had better be 
destroyed. 

Fracture of the small sesamoid occurs most commonly as complica- 
tion of old navicular disease or as the result of a punctured wound (nail) 
of the foot ; it may also occur after a jump or under the influence of a 
violent effort. We observe it quite often in the feet of horses which are 
used for the exercises of surgery or of shoeing. 

The diagnosis is very difficult. With wound from nail in the foot, it is 
■only made out when the bone has been exposed. In a similar case, 
Humbert removed the whole bone and placed the horse unrler continued 
irrigation ; three months after he was able to trot. This case, however, is 
unique. IMoller has performed several times this sesamoidectomy, ab.vays 
with fatal results. If the fracture occurs without apparent cause, without 
traumatism, as in the case of Mollereau, positive diagnosis is impossible; 
the accident can only 'be suspected. The severity of the lameness, the 
■Sensibility of the foot and coronet to torsion and extension, allow only the 
affirmation of the presence of very severe lesions at the bottom of the foot. 

Long rest, cold irrigations, later on neurotomy, constitute the treatment. 
The patient of Howell recovered only a long time after firing of the 
coronet. Notwithstanding the use of slings, blistering of the coronet, 
continued irrigation, the patient of Mollereau grew worse. It had to be 
killed. The small sesamoid was broken in several pieces, and the tendon 
of the perforans entirely ruptured. 

IV. 
PERIOSTITIS— OSTEITIS— OSTEOMYELITIS. 

Intimately related in their anatomical connections and functions, made 
solidary of each other by the blood-vessels which penetrate them, the 
various constituting parts of bones — periosteum, bony tissue, and marrow 
— may be affected by the same morbid causes, altered in the same or in 
different degrees, according to whether they are attacked at once or 
successively invaded. It is also possible for the inflammation to remain 
localized a certain length of time or again during all its course only to 
the periosteum or the bony tissue itself. 

Acute periostitis terminates in resolution, suppuration or the passage to 
xhrofiic state. Resorption of inflammatory products and the return to 
normal state of the affected tissue is seldom seen. If the inflammation 



456 VETERINARY SURGICAL THERAPEUTICS. 

becomes suppurative, the fibrous layer of the periosteum is loose from the 
osteogenous coat, a sub-periostic abscess is formed, sometimes a more or 
less extensive portion of the bone becomes necrosed. At the beginning 
of acute periostitis, one may endeavor' to arrest the inflammation by 
cold. When the affection attacks a bone of the extremities, continued 
irrigation is a good way. In the very rare cases where pain continues 
to be very acute, suppuration is to be looked for ; this detected, an early 
incision of the peri-bony tissues and of the periosteum must be made^ 
The after treatment consists in antiseptic injections in the wound and a 
blistering friction over the diseased region. If the superficial layer of 
the bone is in course of exfoliation, injections with weak solution of 
muriatic acid (i p. 100) are advantageous. 

Chroni: periostitis, limited, and very common, ys, ossifying, osteoplastic or 
fibrous. The first variety, which occupies the osteogenous layer and also, 
almost always, the superficial layers of the bone, brings on a more or less 
abundant production of osteophytes. It is that variety of periostitis which 
gives birth to exostosis, so frequent on the level of the insertion of 
articular ligaments in horses. Fibrous periostitis, ordinarily secondary, 
connected with a surrounding inflammation, is more peculiarly localized 
to the external coat of the periosteum, which becomes thick and unites 
to the surrounding tissues ; often, there is at the same time a slight sub- 
periostic, bony neoformation, in the whole extent of the inflamed ter- 
ritory. When the affection is yet comparatively recent, if the pain is 
acute, cold lotions, baths or continued irrigation are useful. But one 
must not expect to control, by them, the bony neoformation. Massage, 
properly applied, associated with pressure, offers better advantages. Later 
on blisters, or firing with superficial or deep points, should be resorted 
to. Periostotomy, made when the affection is still recent, may reduce the 
pain, when it is severe ; it has but a weak action upon the neoformed 
osseous tissue. 

Diffused osteo-periostitis, generalized to most of the bones of the skele- 
ton, those of the legs principally, is observed sometimes in dogs (Fig. 99).. 
The affected bones are literally covered with bony growths, forming ordi- 
narily a layer of nearly an even thickness, hollowed with narrow depres- 
sions filled by fibrous tissue. We have made autopsies on two dogs, in 
which all the bones of the legs were affected with these autogenic perios- 
titis. In the museum of Alfort, there is a skeleton where these lesions 
are very interesting. In a case observed by Kitt, and where the histolo- 
gical characters of osteo-periostitis were missing, the author admits that it 
was a case of bony hyperplasia, myopathic in origin. The disease is. 
rebel to all treatment. 

Traumatic osteitis, promoted by efforts, contusions, wounds of bones,. 



PERIOSTITIS — OSTEITIS— OSTEOMYELITIS. 



457 



fractures, are exposed or covered, according as the soft peri-osseous parts 
are divided or only bruised. Covered osteitis demands only rest, cold 
douches, compression, massage or resolutive applications. In the bony 
tissue, protected from germs, inflammation is slight, at first rarefying, then 
productive and ending in the integral reparation of the phlogosed tissue. 
With us it is a rule, with our patients, to apply upon the entire affected re- 
gion a blistering preparation, which helps the development of the process. 
As we have said, the fracture of the weakened bone is the principal com- 
plication to be looked for. Hence the indication to keep the patient at 
rest for a more or less long time, according to the severity of the trauma- 
tism, and in serious cases, to keep him in slings. After recovery, there 
remains sometimes an exostosis whose treatment is the same as that of 




Fig. 99. — Dog suffering with osteo-parosis of the legs. (From a photograph.) 



other osseous neoproductions. This termination is the rule with chronic 
osteo-periostitis. Covered traumatic osteitis may, however, end in sup- 
puration, when pyogenous microbes are carried there by the circulation. 
But this termination is specially frequent in open traumatic osteitis. (See 
C a lies J) 

Actinomycosic osteitis is common, specially in the maxillary bones ; 
botryomycosic osteitis is very rare. (See Actinomycosis, Botryomycosis.) 

Tuberculous osteitis, frequent in man, is less known in animals. It has 
been specially observed in cattle and birds. It is rare on the diaphysis, 
but in preference occupies the epiphysis or the short bones. In bovines, 
it was seen on the tibia and the humerus (Moule), the ribs (Moulb), the 



458 VETERINARY SURGICAL THERAPEUTICS. 

cervical vertebra (Caudwell, Coremans). In birds, it is frequent, specially 
in parrots (Larcher, Eberlein). (See Tuberculosis >) 

Glatiderous osteitis, in horses, is actually without interest from the thera- 
peutic point of view. We will only mention it. The abscesses which, in 
the course of this affection, occur in the periosseous tissues, may reach 
the bone and give rise to osteitis and osteomyelitis. There are cases 
where osteitis occurs without previous alteration of the surrounding soft 
tissues ; the diagnosis is then sometimes very difficult. At the post- 
mortem of a glanderous horse killed on account of an incurable lameness 
of the left foreleg, Nocard found a voluminous abscess in the diaphysis of 
the humerus. This bone " seemed to have sustained a considerable 
swelling in all its superior half; a thick layer of fibrous tissue, indurated, 
lardaceous, infiltrated with serosity, surrounded it and was intimately 
united to it." In the superior part of the medullary canal, there was an 
abscess as big as a hen's egg. 

Rheu7natoid ostcititis appears very rare in all species. It assumes, 
almost always, a chronic march, intermixed with acute access, of very 
long duration, and ends ordinarily by the production of an hyperostosis. 
Rheumatism of bones demands a long treatment ; and when by the ad- 
ministration of salicylate of soda or other agents, the acute symptoms are 
controlled, alkalines and arsenic preparations must be used. With them 
a tonic diet and moderate exercise are essential. The local treatment, 
at most of little benefit, does not differ from that of simple osteitis ; it 
includes blisters and cauterization. 

Diffuse spontaneous osteomyelitis, which affects long bones near the 
epiphysar cartilages, is well known in man. Bacteriological researches 
have taught that staphylococci are its ordinary agents ; other micro-or- 
ganisms (streptococci, coli-bacillus, micrococcus tenuis) may produce it. 
It seems as if the pathogenous elements, carried by the blood, need an 
exciting cause to enter into action. A blow, a knock, is sufficient to 
create a center of less resistance, in which the micro-organism can come 
to proliferate and create lesions of the highest gravity. Epiphysar loose- 
ness, arthritis, prevalent and septic infections are the possible complica- 
tions. 

This disease is little known in animals. It was produced experiment- 
ally on young subjects by associating the trauma to the injection of staphy- 
lococci in veins. We have seen a remarkable case in a two-year-old colt. 
Cultivation of the bony marrow has given colonies of staphylococci. 

When a single bone is affected, the disease recent, and the troubles 
not too great, treatment may be followed by recovery. (See Caries and 
Necrosis.) With diffuse osteo-myelitis, when specially several bones are 
affected, it is useless to undertake treatment. 



CARIES — SUPPURATIVE OSTEOMYELITIS. 459 

V. 

CARIES— SUPPURATIVE OSTEOMYELITIS. 

This affection, known in veterinary practice under the name of canes, is 
•essentially characterized by the interstitial suppuration of the bony sub- 
stance, accompanied with necrobiotic manifestations and terminating with 
the complete destruction of the invaded bony structure. 

Promoted by pyogeneous microbes, specially the staphylococcus aureus 
and albus, it corresponds to the traumatic osteomyelitis of human surgery 
— the term cai-ies being applied specially to bony tuberculosis by surgeons. 

Peri-osseous suppurations may be complicated with caries. Bony 
wounds made by soiled instruments generally bring on the same result. 
In animals, as well as in man, caries may be related to a general 
morbid state ; it then may appear without apparent producing cause. 
Anyhow it is possible for the micro-organisms to be carried in bones by 
the circulation : Rodet and Jacoulay have produced osteomyelitis and 
bony suppuration by injecting cultures of staphylococci in the veins of 
rabbits. But, in the majority of cases, caries is due to local causes. The 
superficiality and the porosity of bones predispose them to it. In horses, 
the last phalanx, on account of its structure, the frequency of the trauma- 
tisms which affect it and the infectious processes that follow, furnishes the 
very great majority of the cases of caries met with in our practice. The 
.navicular bone, the spinous processes of the withers, the maxillaries, are 
also frequently affected. 

The treatment must have for object the rapid and complete elimination 
of the invaded bony structure, and the transformation of the morbid 
center in a simple bony wound, whose repair will go on rapidly in the 
■ordinary way. There are two methods to choose : in one, exclusively 
surgical, the entire carious part is excised with the sharp instrument ; the 
other, more conservative, consists in transforming the carious part into a 
true chemical scar analogous to the splinter of necrosis, likely to promote 
as it does, on its periphery, a moderate inflammatory process sulificient for 
its elimination. By this second mode, one, as Oilier says, attempts to 
" necrotize " the carious bone — to give it artificially the physical and 
•chemical characters of the bone, necrosed spontaneously. 

The use of either of these processes is dependent on various circum- 
stances, specially the seat of the caries and the disorders it has given 
rise to. In all cases, however, it is indicated to interfere as soon as 
possible. 



460 VETERINARY SURGICAL THERAPEUTICS.' 

The treatment of caries by actual cauterization goes back to old time ;; 
it was freely used by old hippiatres, who had borrowed it from human 
surgery. Lafosse, who had seen many of its good results, said : " The red 
iron makes a non-contagious eschar and the suppuration, which follows its 
application, is a true knife with which nature separates the diseased from 
the healthy tissue." Cauterization not only makes eschars of the carious 
parts, but it creates in the surrounding region a true, eliminating and 
cicatricial inflammation. Repeated cauterization has often been used 
uccessfully in costal caries, which had resisted other forms of treatment. 
The operation must be done according to some rules : when the disease 
affects bones situated in the neighborhood of important organs (cranium, 
ribs, extremities of long bones), the cauterization must be done slight for 
a few moments, done at several seatings, one or two days apart, to such 
effect that the heat would not penetrate as far as the organs that these 
bones cover or protect ; spongy bones should be burnt for a longer time 
than those that are dry or compact, on account of the great quantity of 
fluid which, escaping for the first, rapidly put the heat out, and also be- 
cause caries affects them more deeply. 

A great number of chemical caustics have been advocated against 
caries ; emetic (St. Cyr), chloride of zinc, nitrate of silver, more or less 
diluted mineral acids, specially sulphuric (Pollock, Mollereau). We do not 
like this treatment. Not only are those agents powerless to arrest the 
caries, but they may give rise to severe disorders in the soft parts which 
cover the diseased bone. 

Every time that one wishes to interfere directly and easily upon the dis- 
eased bone, he must proceed with the removal of the carious tissue. This 
is the way that all caries of the third phalanx must be operated. There, 
the operation consists in exposing the tegumentary membrane that en- 
velops the phalanx, in freely excising all portions of the velvety and 
podophyllous tissues, which are gangrenous or on the road to mortification ; 
then, with a sage knife, the drawing knife or a curette, remove layer by 
layer the part of bone that is dead, until the surface exposed gives evi- 
dence of its vitality and perfect integrity by its normal resistance, its 
rutilant coloration on exposure to the air, through the bloody oozing which 
comes from the areolae of the spongy tissue all over its surface. When 
this presents still in some points a bony tissue with a brown, purplish or 
yellow-greenish color and if pressure brings on the oozing of some traces 
of pus or sanious fluid, the curette must hollow all these points, until 
sound spongy tissue is reached ; it is better to scrape some of this than to 
have the smallest portion of diseased tissue left behind. Often, after 
trying to preserve a thin layer of the os pedis, one is obliged, two or three 
days later, to make a large cut in the foot, remove a wide piece of the 



NECROSIS. 461 

tegumentary covering and cut deeply into the phalanx. It has been rec-^ 
ommended to limit the scraping of the carious part inside the limits of 
its extent, and to complete the operation by the application, on the dis- 
eased part, of a small wadded tent impregnated with caustic fluid, such 
as sulphuric acid diluted to the third or the quarter. These caustic solu- 
tions were supposed to have the great power of limiting their action to 
the extent of the altered structures. We have already stated how erroneous 
this belief is. It is better to be done with the caries at once, to scrape 
down to healthy tissue and apply an antiseptic dressing. In cases of 
caries of the third phalanx, when, exceptionally, the podophyllous and 
velvety tissues are sound, they must be respected : their preservation is 
of the utmost importance for the repair of the new hoof. In such in- 
stances, the fragments of the membrane corresponding to the caries must 
be carefully dissected to expose the diseased bone (Bouley). In other cir- 
cumstances, the periosteum must be carefully saved. It should be sepa- 
rated carefully from the bone, so as to preserve it and have it co-operate in 
the formation of new bone. Upon the saving of the internal cellular layer 
of the periosteum depends, indeed, the regeneration more or less rapid and 
perfect of the destroyed bone ; daily practice in human surgery proves it 
sufficiently. Very extensive alterations may necessitate amputation in 
small animals. The special rules of the treatment of caries in some regions 
are indicated in the chapters relating to those affections. (See Vol. II.) 

The general indications, so important in the caries of man, are, however, 
secondary to all animals. Yet in dogs there are cases where it is ad- 
vantageous to administer cod liver oil, quinine, Fowler solution or alka- 
lines. 

VI. 

NECROSIS. 

Necrosis, dry caries, dry gangrene of bones has a complicated etiology.. 
In animals traumatism is a great producing cause. Bones of the extrem- 
ities are, on that account, most exposed; the radius and the tibia are those 
where it is generally observed, by the fact of the frequency of the con- 
tusions to which they are exposed and their want of protection on their 
internal face ; phalanges, scapula, sternum, maxillary, offer also frequent 
examples.* 

Several diseases, distemper among them, are sometimes accompanied with 

1 An unusual case of necrosis of the dorsal vertebrae is reported by F. Allen, D. V. S., 
"vshich gave rise to progressive paraplegia in an old horse, which ended fatally, and at 
the post-mortem of which the annular portion of the 7th, 8th, 9th and loth dorsal 
■vertebrae were more or less necrosed. — Amer. Vet. Review, vol. 8, page 360. 



462 VETERINARY SURGICAL THERAPEUTICS. 

bony lesions, bringing with them more or less extensive mortification ; lead 
and phosphorus poisoning must have the same nocive action in animals 
as in man, but facts to this effect are wanting. 

The size of the sequestrum varies much. Sometimes it is but a very- 
small piece of bone, or even small fragments (parcellar necrosis) ; in some 
cases (panosteitis) mostly the whole bone is affected. Sequestra are 
exposed or iiiz'aqinated. The museum of Alfort contains several specimens 
of invaginated scapula. We have seen two beautiful ones in Lyon. On 
a horse affected with comminuted fracture of the scapula, Chuchu extracted 
first a few splinters, then after two or three months, a sequestrum from the 
anterior angle of the bone. In the observation of Barrier and Gervais, 
it was a mare which had received a kick on the anterior border of the 
right shoulder, about twelve centimeters above the shoulder joint ; a blister 
was applied and the patient put to rest ; the lameness, first slight, increased 
little by little ; extremely serious symptoms became manifest, the animal 
dropped in the slings and was killed. The necrosed scapula was covered 
with an osteo-cartilaginous envelope of new formation. Jacquot has re- 
ported the case of a yearling colt, convalescent from distemper, which 
received a kick on the superior part of the forearm ; the fistulous wound 
that followed was treated by blistering and antiseptic injections ; an 
enormous swelling occurred with other numerous fistulas from which 
escaped an abundant suppuration. He was destroyed. At post-mortem 
an extensive necrosis of the radius was found with sequestration of the 
necrosed portion. 

If all denuded bony surface is predisposed to necrosis, infection 
plays with it the primordial part. A piece of bone, deprived of cir- 
culation, but aseptic, is tolerated by the tissues ; it does not promote 
suppuration, it may become grafted, and the characters of this asep- 
tic necrosis are very different from those of infectious mortifications. 
Therefore, as soon as a bone is exposed, isolated from its periosteum, 
it must, after minute disinfection, be covered with an antiseptic prep- 
aration (iodoformed, phenicated or boricated vaseline), which prevents 
its desiccation and protects it from external agents. 

When mortification exists, the treatment includes four indications; ist, 
hasten the limitation of the necrosis ; 2d, favor the elimination; 3d, pre- 
vent infections ; 4th, activate the repairs. When necrosis has affected 
but a very limited and superficial surface, as is seen frequently with some 
bones, simple antiseptic injections are sufficient to prevent all complica- 
tions ; by the local reaction alone, the sequestrum is eliminated and the loss 
of substance is rapidly filled up. In bygone days, escharotics and caus- 
tics were frequently used ; some exclusively employed tincture of iodine 
or Villate solution in injections through the fistula ; others cauterized it 



NECROSIS. 



463 



"with the red iron. (Fig. 100.)^ To-day, phenicated water, liquor of Van 
Svvieten, chloride of zinc (10 p. 100) are mostly used. Though the slough- 
ing of the sequestrum takes place slowly, there is no need to remove it 
with sharp instruments. Leave the work to nature. Often the gouge or 
the dressing knife would remove too little or too much of the tissue. 
However, if it was feared that the inflammation might spread to other 
important organs, it would be advantageous to excise the dead part and 




Fig. 100. — Necrosis of the scapula. S, sequestrum. (Specimen of the Afort School.) 

Stop only when healthy tissue is reached, easily recognized by its aspect 
and the blood that oozes over the section. With these exceptions, the 
disjunction must be left to take place spontaneously. 

During the time that the separation between the dead and the living 
tissue goes on, some special cares are necessary to avoid complication. 
Abscess should be open, purulent undermining freely cut at dependent 

1 In the museum of the American Veterinary College there is a specimen similar 
to that represented in Fig. 100, the entire scapula being enveloped and moving loose 
in it. 



-464 VETERINARY SURGICAL THERAPEUTICS. 

parts and drained ; frequent antiseptic irrigations will prevent purulent 
resorption. 

As soon as delimitation is operated the pus changes aspect ; from 
serous, it becomes whitish, thicker ; at that time, if the sequestrum 
is isolated and not incarcerated, nothing is easier than to extract it. 
After free incising, it is taken hold of with forceps and brought outwards. 
— PhaIa7igectoniy has been performed by Garcin (1834) on a mule, suf- 
fering with a nail in the foot ; the os pedis, entirely necrosed, was held 
only by "a very small ligamentous band," it was removed entirely; after 
four months the animal " was returned to work, and though lame, was 
able to do it for two years after.'' In a heifer suffering with nail in the 
foot with necrosis, Delafond, in 1838, performed sesamoidectonty. 
^' Nineteen days after, there was scarcely any lameness, the animal re- 
covering completely." 

The operation is also easy when the bone, though invaginated in a thick 
"bony box, communicates with the exterior by a large opening, through 
Avhich it may pass ; it can be secured and brought out with forceps. 
When the cloaca are narrow, recovery is more difficult ; it necessitates 
sequestrotomy .or necrotomy. If the sequestrum is left to itself, suppura- 
tion becomes abundant and the patient becomes weak; but hasty inter- 
ference is dangerous ; the bony envelope must be of a sufficient strength 
not to break during the manipulation of the operation — a point of great 
importance, should it occur on bones of an extremity. 

Interference decided upon, the soft parts are divided, in saving blood 
vessels and nerves, and the incision connecting all fistulous tracts together, 
as much as possible. The region being chronically inflamed, the hemorrhage 
is always abundant ; esmarchisation, or at least a rubber cord placed at 
the upper part of the leg, are good precautions. Reaching the bone, the 
periosteum is dissected loose, and then, with the trephine or the gauge 
and mallet, a piece of bone is removed, wide enough to permit the ex- 
ploration of the suppurating cavity. Sometimes one meets with a dia- 
physis entirely necrosed, then he is obliged to enlarge the opening, " to 
remove the cover of the bony coffin where lays the dead diaphysis." In 
such cases, it is prudent to divide the sequestrum, so as not to reduce to 
excess the resistance of the protective envelope. The cavity is curetted, 
irrigated, plugged with iodoformed gauze ; antiseptic dressings favor the 
complete repair of the trauma. One can conceive the disturbances that 
such operations demand and how long inust recovery be. In very young 
subjects, where repairing power is great, success is possible ; but often 
lameness remains, incompatible with economical exploitation of animals. 
For this reason, in large animals, abstention is the rule, even when the 
extraction of the sequestrum is easy. 



EXOSTOSIS. 465 

To avoid the always serious operation of sequestrotomy, chemical agents 
bave been recommended to obtain the dissolution of the necrosed tissue. 
Some twenty years ago, Pollock recommended in man, the use of sulphuric 
acid mixed with its weight of water. Painted over with this solution, the 
sequestrum becomes soft, brittle, it is partly dissolved and the rest is elim- 
inated by suppuration. Marcacci recommended perchloride of iron to 
activate the delimitation. For him, this agent irritated the healthy living 
structure and promoted the formation of numerous capillary vessels which 
soon isolated the necrosed from the living parts. Morris more recently has 
advanced another process. The fistulas being enlarged with the knife, he 
injects a solution of muriatic acid (2 or 3 p. 100), which dissolves the 
calcareous elements of the necrosed bones without acting on the living ones. 
A chlorhydropepsic solution thus used and composed of : muriatic acid, 
16 drops; pepsine, 2 grammes; distilled water, 120 grammes, digests the 
caseous and fatty detritus remaining of the decalcified bone. In using 
alternately both solutions, the sequestrum is rapidly destroyed and re- 
covery obtained. 

In preference to these chemical treatments, the more rapid and more 
certain operating methods are generally in use. 

During all the time of the treatment, the patient should receive gener- 
■ous diet, stimulants and tonics. The progress of the disease should be 
•carefully watched, and the complications likely to occur avoided. 

VII. 
EXOSTOSIS. 

Result of a productive osteo-periostitis, exostosis are particularly fre- 
<iuent in the extremities, where many receive special names. In a gen- 
eral way, the name of exostosis is given to well defined bony tumors ; that 
of periosiosis to diffused neoformation ; that of hyperostosis to the in- 
crease in size of a bone in its dimensions. In the point of view of 
their structure they are divided into: 1st, e^urnate^ exostosis, contain- 
ing no blood vessels; 2nd, compact exostosis, formed of dense tissue ; 
3d, spongy exostosis, made of areolar tissue. In relation to their seat, 
they are epiphysar, developed on the surface of bones ; parenchymatous^ 
formed in the thickness of the bone ; enostosis, occupying the medullary 
, canal. 

For a long time, observers have noticed that exostosis developed spe- 
cially on a level with the surface of insertion of the principal ligaments ; 
osselets, on the points of attachment of lateral or interosseous ligaments ; 
splints, on the line of interosseous fibres ; ringbones of the pasterns, near 



466 VETERINARY SURGICAL THERAPEUTICS. 

the point of ligamentous insertions. Exostosis of the rachidian column 
take place also at the insertions of the inferior common vertebral, in- 
terspinal or articular ligaments (Goubaux and Barrier). Whatever may 
be the power of a muscle, exostosis are almost never found at the point 
of insertion of its terminal tendons. The few exceptions to thio rule are 
met with in tendinous cords, which on some parts of their course play the 
part of ligaments. These facts are easily explained, if it is thought that the 
ligaments of extremities have to support the reactions from the ground, 
while tendons stand only the more or less powerful actions of the muscles 
they terminate, which is far inferior to the great traction that the whole 
mass of the body, sometimes loaded heavily or animated by rapid gait, 
gives to the agents having for duty to hold the articular surface in rela- 
tion (Barrier). Traumatisms are frequent causes of exostosis. Violent 
pressures, surrounding inflammations, youth, heredity, play a more or 
less important part in their development. Let us mention the exostosis 
called ostcogenical, appearing without evident cause, and among them, ia 
particular, the cranian exostosis met often in bovines (Goubaux). 
■ The manifestations given by exostosis vary according to their seat, age 
and size. Renault has seen in a horse two bony growths of the frontal 
portion of the cranian cavity which gave rise to immobility, by pressure 
'upon the brain. Neyraud has mentioned a case of paraplegia due to 
strangulation of the spinal cord by an intra-rachidian exostosis. Bony 
tumors of the pelvis, often following fractures, may wound or perforate 
the bladder or the intestines (Bouley Jr., Coulbaux, Patu) or interfere 
considerably with parturition (Favre). 

But the most frequent and most important exostosis, from the point of 
view of practice, are those that develop on the bones of the extremities 
of our animals used as motors. During the whole course of the osteitis 
which prepare and develop them, they may interfere with tendons, disturb 
the regular functions of joints, press upon blood-vessels or nerves. 

After Hunter and Cooper, some authors, to make bony tumors disap- 
pear, have recommended the administration of diluted mineral acids — 
a poor way which has never given good results. If success has been 
claimed, it must be attributed to the evolution of the organism alone. 
The existence in young horses of bony growths which are temporary, and 
are resorbed with age, is well known. Many practitioners, Liard and 
Gillibert among them, have mentioned cases of spontaneous disparition of 
these exostosis. In general, however, those tumors are tenacious. To 
obtain their resolution, blisters and alteratives have been recommended. 
Tincture of iodine, charge of Lebas, that of Girard, have had their day. 
To-day, cantharidis blister, that of mercury, red ointment, are the prepara- 
-tions most in use. Bichromate of potassae, tried first by Neff, Fcelen, has- 



EXOSTOSIS. 467 

given good results to Schmid, Peuch, Lamouroux. It is made in proportion 
of I to 16, }i, }{, Yi. " The bony tumors, which Uke ringbones and callous 
spavin, frequently give rise to tenacious lameness, demand friction, repeated 
often with ointment, }^ io yi ... . If one uses an ointment to the 
i6th, 12th or 8th, and rubs it slightly a few days apart, the treatment 
will leave no mark. If, on the contrary, a stronger ointment is used, if 
the frictions are frequent and severe, the bulbs of the hair are destroyed by 
the caustic, and the animal more or less blemished. The slough of the 
eschar is always slow ; sometimes even, when the quantity of bichromate is 
very small, it falls off unnoticed. In some cases, however, there is forma- 
tion of a small quantity of pus." * 

The numerous topics with secret composition, liquid fires, liniments, 
ointments, pomatums, praised against bony blemishes, have no superiority 
over the mercurial blister or ointment of biodine, which remain the agents 
most commonly used. There is some advantage to percute the tumor 
slightly with the plessimeter before applying the blisters. Flagellation and 
massage, already used in old times, have again been recently advocated by 
Felizet. Pressure over the tumor is a method of Lafosse, reintroduced by 
MoUer. It is seldom used. When blistering has failed, firing is indicated. 
It has been advocated under all its forms : in superficial points, lines, deep 
points. We prefer this last mode, which reaches the bone itself and gives 
rise in it to high inflammation ; we pierce the skin through with one or 
two strokes of the cautery, penetrate into the bony tumor and cover the 
cauterized surface with a coat of blister. Praise of the penetrating 
points needs not to be made. Rey, Leblanc, Andre, Lavendhomme, Fou- 
cher, Abadie, have proclaimed the excellence of the method. 

But there are cases where cauterization fails : it is for them that the 
bistouri has been recommended. Sewel, professor in the veterinary col- 
lege of London, invented, to produce the resorption of exostosis, the 
division of the periosteum on their surface. This operation — perios/oto?ny — 
has been used but little in France. To perform it a kind of bistouri having 
a strong blade with convex sharp edge and blunt point is used ; at the base 
of the exostosis an incision is made in which the periostotome is engaged ; 
pushed flat-wise under the skin, until it reaches the superior border of the 
tumor, the sharp edge is then turned on its surface and the periosteum is 
divided. According to Sewel, only a slight inflammation follows, and after 
ten or fifteen days the animal can resume its work. Reynal has obtained 
no good results with this operation. Bouley found it advantageous for 
subcutaneous growths, as splints, but " it is not the same with those 
situated under a complex fibrous apparatus, as ringbones and spavins, 
"which cannot be interested in their thickness without having first divided 

1 Peuch, Journal de Med. Vet., 1868, p. 440. 



468 VETERINARY SURGICAL THERAPEUTICS. 

the thick coat of tissues, rebel to the inflammation, wh ich covers them ; 
and besides that, for certain ringbones as for some spavins, the im- 
mediate neighborhood of the articulations is one of the most important 
circumstances which make us reject the idea of the application of peri- 
ostotomy, as being at least useless and certainly dangerous." We will 
see that there is indication for it, that it may render service and that, 
performed antiseptically, it is harmless. 

The ablation of bony tumors is seldom performed. The operation, easy 
for pedunculated growths, is difficult for the others, that have a broad base 
of attachments on the bone. It is reserved for some exostosis against which 
other means would be powerless, specially those of the face. Incomplete 
side bones are quite frequently removed, and when a portion of them is 
necrosed. As for the gouging out, with the mallet and gouge, in cases of 
phalangeal exostosis, splints, spavins, etc., it is a condemned method. 

Neurotomy performed above the fetlock, the median or the sciatic, 
according to the localization of the exostosis, is a last treatment which 
•may succeed when firing has failed. 

Exostosis are quite common in birds. They develop in preference on 
the bones of the legs, sometimes those of the trunk ; either without ap- 
parent cause, or after traumatisms. Hyperostosis of several regions of 
legs have been observed (J. Hunter). Muyschel and Adamovics have 
related cases of generalized hyperostosis in gallinaceous (Larcher). 

Special Exostosis. 

/. — Osselets. 

Bony tumors of the knee, osselets are generally situated on the lateral 
faces of that region and on the head of the metacarpals. They represent 
high splints, a name under which they are commonly known. More 
frequent on the inside than the outside, they may be double, and in that 
case the internal one is more developed than the external. They are 
sometimes situated in front of the knee, on the bones which form that joint. 
When they are in large number, and in connection with the presence or 
the absence of synovial dropsies, the knee is said to be hooped. 

The prognosis of those exostosis varies very much according to their 
seat. Developed on the anterior and lateral faces of the knee, they in- 
terfere with the movements of the joint, produce a pseudo or partial 
ankylosis and a more or less lasting lameness, while those located on the 
metacarpals, like splints, generally produce only temporary lameness. 

More serious than ordinary osselets is the exostosis, met in race horses, 
which is spread on a level with the trapezium and the tendons inserted 
upon it. This exostosis, almost always following an effort, a partial lacera- 



EXOSTOSIS. 469 

tion of the tendons at their point of insertion, gives rise to a lameness of 
long duration, due to the periostitis and tendinitis, while it grows and in- 
terfering with the function after its full development. On a three-year-old 
that we watched the lameness lasted fifteen months. On another, for two 
years after there remained some stiffness at the start. Most of the 
.practitioners who have seen this lesion believe that it is the sequelae of a 
fracture of the suscarpal bone. 

As soon as the diagnosis is made by the lameness, the sensibility and 
a slight swelling of the part, rest must be prescribed. If blistering and 
.firing do not obtain the removal of the bony neoformation, they often 
have the advantage of removing the lameness. For osselets that resist 
firing, median neurotomy is indicated. 

//. — Sj>a7nn —Tarsal Osteo-arthritis. 

The hereditary transmission of some defective conformations of the 
hock (narrow, bent), perhaps also a want of resistance, plays an important 
part in the development of spavin. Through the efforts of pulling, rapid 
traveling, rearing, jumping, the articulation of the hock receives pressures 
liable to injure the ligaments, synovials and bones ; specially in young 
animals, whose organs have not reached their full development, these are 
the principal causes of the disease. 

If spavin is sometimes only a high placed exostosis, most generally it 
invades tarsal articulations. In that case, it is at times superficial, due to 
ligament tears, and forms on the lower tarsal articulations a kind of callus, 
assisting ankylosis (Aronsohn) ; at others, and more frequently, it is the 
expression of several dry arthritis which result in the ankylosis of the in- 
flamed joints. According to the seat of the bony tumor, we consider the 
metatarsal spavin, occupying the superior part of the internal face of the 
cannon, and the tarso-metaiarsal or articular, spreading over the articula- 
tions of the hock. This last offers several varieties : in the first, the 
external tumor and the ankylosis are limited to the articulation of the 
cuneiform bones with the metatarsal ; in the second, the lesions involve 
also the joint of the scaphoid and cuneiforms ; in the last, the astragalus is 
united to the scaphoid. In a similar way, spavin is spread more or less 
transversely and when its dimensions are ^educed, its prominence is 
situated at times forward, towards the bend of the knee, at others more 
backward. 

During the development of spavin, when the lameness is already very 
great, often no abnormal projection is detected at the base of the hock ; 
morbid sensibility is very little marked or absent, which renders the 
diagnosis difficult and shows that the lesions truly began in the bottom 



470 



VETERINARY SURGICAL THERAPEUTICS. 



of the articulations. At this stage, the pains due to the osteo-arthritis are 
often very great. In walking, there is a sudden flexion of the hock,, 
analogous to springhalt. However, this symptom is quite rare, and still it 
may be observed when there is no alteration of the tarsal articulations. 
That which is most frequently seen is an abnormal, more or less marked, 
stiffness of the hock. The sudden flexions of the cannon increase the 
lameness ; sometimes the animal falls when turning short. But those 
phenomena are not characteristic. Many latent spavins are diagnosed 
only by exclusion and by the old ideas of extreme frequency of 
hock lamenesses. It is often only after six weeks, two months or even. 





Fig. loi. — Spavin, seen from forward, Fig. f02. — Spavin, seen from behind,, 
left leg. right leg. (Goubaux and Barrier.) 

later, that, on the ordinary seat of spavin, a bony tumor, gradually increas- 
ing, is detected. Then the pains resulting from the arthritis being much 
reduced, the lameness diminishes little by little. 

Without doubt, spavin is one of the most severe lesions of the locomotory 
apparatus. One of the most authoritative old hippiatres has said : 
** Any horse with one or two spavins of steer will never be useful." The 
prognosis varies with the age, size and situation of the tumor. Observa- 
tion has taught that spavins are so much more serious and rebel to treat- 
ment that they are situated more forward and nearer to the fold of the 
hock. We must not count on the " rcstitiio ad integrum " of the invaded 
joints ; but in a large number of cases, one succeeds in removing the 
lameness. Authors who, like Lemichel, claim that " spavin never for- 
gives," have evidently exaggerated the rebel tendency of the affection.- 



EXOSTOSIS. 



471 



The removal of the lameness is obtained in the greater half and even two-' 
thirds of cases. 

When osteo -arthritis of the hock is considered the cause of a recent lame- 
ness, when a spavin is suspected, long rest is the primordial indication. 
Even at the outset, it is at least doubtful if long immobilization will succeed 
in obtaining the disappearance of the inflammatory symptoms with which 
the subastmgalian joints are affected, so that everything will return to its 
normal state. In most of cases, a relative recovery only is obtained — 





Fig. 103. — Spavin. Front view of dis- Fig. 104. — Vertical transverse section of 
sected hock. a spavined hock. 

simple or multiple ankylosis, limited or extensive — and all the treatments 
recommended act satisfactorily only in favoring it ; existing articular 
lesions, even recent, are incurable. 

By rest and blistering applications (mercurial blister, red ointment, 
sublimate ointment i to 6) on both faces of the joint, the lameness may 
be made to disappear, when the spavin is tarsal and on the way to 
development ; as soon as the animal is returned to work, the lameness 
leturns. Blistering frictions, even repeated, have a too superficial action ; 



472 VETERINARY SURGICAL THERAPEUTICS. 

they seldom give a successful result. It is an error to hope that by their 
use one will succeed in changing or arresting rapidly an articular inflam- 
mation, which has its productive conditions always present and will feel 
their action as soon as work is resumed. 

The application of these agents subcutaneously has been recommended 
(Bassi, Buch). Bassi makes over the spavins two or three cutaneous inci- 
sions, converging downward, scarifies the subdermic connective tissue 
and then applies the blister. 

The empiric mentioned by Cattrall made a longitudinal incision on the 
skin of the spavin, separated it from the tissues underneath forward and 
behind, then introduced powdered sublimate in the wound, which he 
sewed with three stitches. Often the slough of a piece of skin, the open" 
ing of the synovial or a bony necrosis vvere the sequelae of this treatment- 

Setons, recommended y^ars ago, are to-day almost completely aban- 
doned. To them blisters and later on firing have succeeded. 

Cauterization has a stronger and deeper action than blisters. Lines or 
superficial points have their advocates ; but it is better to abstain from 
using it in recent spavins. Gerlach has studied comparatively superficial 
and deep firing, and condemned the latter, which he said exposes to 
arthritis. Modern practice has rehabilitated needle firing. Arthritis is to 
be feared only when the operation is badly done and the joints are not 
yet protected by periostosis ; when the osseous neoformation exists, the 
entrance of the point is not to be feared, when made on its surface. It is 
known anyho\t that fine points or needles can without danger perforate 
articular synovial. Moller, who claims to be a partisan of deep 
cauterization, passes his cautery one, two or three times in the point, and 
often completes the operation with a blistering friction (sublimate oint- 
ment I to 6). Hoffmann applies over the exostosis fifteen or twenty 
points down to the bones. Bottazzi, as well as Nanzio, employed the sub- 
cutaneous method. 

Several special operations have been recommended against spavin. 

Abildgaard, Hering, L. Lafosse, have advised the section of the ciinean 
branch. The operation is very simple. The animal thrown on the lame 
side, the opposite leg is secured on the corresponding forearm. The line 
of incision is indicated by the vertical axis of the internal face of the 
hock ; operating too much forward, the saphena vein or the articular 
"bursa might be injured. The growth itself gives the best point of repair ; 
if it is small, the band is felt over its surface ; if large, it is ordinarily 
divided in two portions by a transversal groove, at the bottom of which 
the band is situated. Sometimes this is raised, stretched or more or less 
deviated by the growth. The hair being clipped, a vertical incision is 
made with the convex bistouri on the selected region, with a length of 4 



EXOSTOSIS. 



473 



or 5 centimeters. When friction or firing have been applied, the skin 
and subcutaneous tissues are indurated, and sometimes a thick layer of 
subcutaneous structure has to be divided before the tendon is exposed; the 
hemorrhage is quite abundant. The index finger introduced into the 
wound detects the tendons, it is raised with scissors introduced underneath 
it, divided with the bistouri and a piece of it amputated. The wound may be 
left open or is closed by one or two stitches. The synovial flow soon 
becomes purulent and may last for two or three weeks, but gradually 
disappears. 

There is often advantage to combine tarsal tenotomy with firing. Im- 
mediate relief, spoken of by Lafosse and Mandel, must not be expected. 
Getting up, animals are ordinarily as lame 
after as before the operation : it demands 
a certain time for the beneficial effects 
to be seen. The mode of action of this 
tenotomy is complicated. Not only does 
it make the tendinous cord loose, the 
pressure of which was one of the causes 
of the lasting lameness ; but it also 
activates the inflammatory process and 
thus hastens ankylosis, in case of recent 
osteo-arthritis. On these accounts it is 
indicated, no matter what are the size, 
the situation or age of the exostosis. 

Dieckerhoff has advised the dividing 
of the cunean sheath from the fold of 
the hock or origin of the tendon to its 
insertion on the cuneiform ; he operates 
with the bistouri, the animal stand- 
ing. After the operation, quite a large 

swelling is formed ; the wound suppurates ; cicatrization takes place in 
two, three or four weeks. Two weeks later, the animal can be re- 
turned to work. In 1875 he made known the results of this practice, 
and out of thirty-six cases of spavin with lameness operated upon, twenty- 
one made an almost complete recovery, eight were improved, seven failed. 

Periostotomy of Peters has given Moller good results. Here is the 
modus operandi. The internal face of the hock well exposed, the hair is 
cut on the lower parts of the region, on a level with the spa /in ; the skin is 
aseptisised. With the bistouri a narrow incision is made, on the inferior 
line of the hock, towards the middle and transversely to the internal face, 
through which cur\'ed scissors are pushed under the skin, first upward and 
forward, and then upward and backward ; thus forming two tracts arranged 




Fig. 



105. — Cunean tenotomy, 
Cunean branch. 



BC, 



474 VETERINARY SURGICAL THERAPEUTICS. 

in V shape. A curved bistouri then introduced into these tracts divide? 
the tissues covering the exostosis and encroaches upon this ; passed in 
the front tract first, with its sharp edge turned backward to avoid injury 
to the vein, then brought over the surface of the bone, with pressure 
on the back of the instrument, the fibro-tendinous tissues are divided 
and the superficial layer of the exostosis incised. Withdrawn, it is then 
passed in the posterior tract, where the same manipulations are executed. 
Treated antiseptically, the wound heals in a few days ; no cicatrix 
remaining. When, by exception, suppuration occurs, there is no serious 
sequelae following. Several times MoUer has carried the instrument into 
the bones without the slightest complication. A rest of four or six weeks 
is necessary. It has been advised to place the animal in slings to prevent 
his lying down. This therapeutic method does not claim to always 
cure spavin, but it does not seem to deserve the reproaches cast on it 
by Schutt. MoUer has obtained by it many successes. When the result is 
incomplete, firing can then be used. 

Neurotomies tried by many have generally failed. The same has been 
the case with the section of the flexor metatarsi when made a hand's width 
above the hock (Klemm). 

Although shoeing occupies but a secondary place in the treatment, 
Klemm, MoUer, Kosters, recommend to apply a shoe with long and thick 
heels. 

For cases where the tarsal lesion is complicated with knuckling, 
after proper shoeing, treatment will be applied at once on the spavin and 
the phalangeal deviation — this last by tenotomy. (See Knuckling.^ 

III. — J a rdc — J a ; -do n . ' 

These two expressions are not synonymous. The latter is situated on 
the external face and back of the hock in the hollow existing in that 
region. The former is applied when the exostosis, more developed, pro- 
trudes beyond the posterior line of the hock, which, instead of being 
straight, describes a curve more or less marked, on a level with the head 
of the external metatarsal. It is proved to-day that this deformation can 
be due to several causes : sometimes to the head of the bone which is 
more developed and more angular than usual, as seen in the progeniture 
of some stallions. That which is commonly taken for a jarde is but a 
fibrous tumor, true tendinitis of the perforans (Barrier) ; but here ex- 
ploration does not give the feeling of a bony tumor. As remarked by 
Jacoulet, growths situated on the posterior face of the principal metatar- 
sal, at the origin of the suspensory ligament, or the dropsy of the tarsal 

1 This is the "curb" of English authors. 



EXOSTOSIS. 



475 



sheath and some small cysts of that region, may give the impression 

of their being true jarde. The researches of Gillet, Sipierre, Goubaux 

and Barrier seem to establish that it does not attack the joints of the 

hock; but always remains limited to the head of 

the rudimentary metatarsal or to the ligament which 

unites it to the principal metatarsal ; a localization 

which explains its benignity, known for long time and 

so expressed by Lemichel : " Jarde forgives always ; 

splints sometimes; spavin never." Some authors, 

however, claim that it may invade the tarsal joints and 

produce a certain tumor of ankylosis analogous to that 

of spavin. Whatever it may be, it is certain that few 

jardes give rise to lameness of any duration and seldom 

do they require treatment. Lameness is great and lasting 

only in cases where there is complication of ankylosis 

or when there is lesion of the perforans. 

Astringents and cool applications are rarely used. 
Blisters and deep cauterization are indicated at once. 
When there is false jarde (cyst, tarsal or thoroughpin), an 
oily fluid escapes through the points. 

IV.— Curb. ^ 




Fig. 1 06. — A, Jard. 
(Goubaux and 
Barrier.) 



Old writers called cu7-b the exostosis which develops outside and 
back of the hock. To-day, notwithstanding the remarks of Palat and 
Sanson, all authors agree in giving that name to the 
bony neoformation developed on the inner side of the 
lower extremity of the tibia, reserving that oi jarde and 
jardons to those of the external and posterior faces of 
the hock. 

Curb is a rare exostosis. It is ordinarily due to trau- 
matisms and lacerations of the ligamentous apparatus of 
the internal face of the hock. 

The diagnosis is easy, even when the tumor exists on 
both legs. On its internal face, the lower extremity of 
the tibia is larger and wider than normal. 

Generally there is lameness only during the period of 
development of the exostosis : in some cases where it 
remains longer, the bony inflammation having reached 
the articular surfaces of the hock, the prognosis becomes 
more serious. 

The treatment of curb does not differ from that of other exostosis. At 




Fig. 107. — Curb. 
(Goubaux and 
Barrier.) 



^ This seems to us the " high spavins" of English authors. 



476 VETERINARY SURGICAL THERAPEUTICS. 

the beginning, blisters, bichromate of potass ointment, ordinarily removes 
the lameness ; sometimes the tumor is resorbed. If these means fail and 
lameness persists, deep points firing is indicated. 

When, by exception, curb extends down the hock, it may give rise to 
incurable lameness. 

V. — Splints. 

They are observed generally on the front legs, sometimes on the hind 
legs. Their frequency in horses recently put to work was well known to 
old hippiatres. Among young horses, which work on pavement, at fast 
gait, many become lame after a few months. Examination of the foot 
and of the leg often reveals no lesions ; the shoulder is suspected ; but 
this lameness, in horses recently working, has ordinarily for cause a super- 
ficial inflammation of the metacarpal bones. Indeed, there soon appears 
upon the region, along the rudimentary bones, a slight swelling, first 
puffy, which soon becomes well defined ; it is a periostitis of the cannon. 
In many of these lame individuals, for the first few weeks, it is very diffi- 
cult to detect even by repeated examination the location of the pain 
(Abadie). Percussion with the plessimeter is not as good to make it out 
as hand examination. The history of the case is important ; ordinarily it 
is that of a horse put to work for a few months which has exhibited 
some temporary lameness. If the foot is not the seat of some mor- 
bid sensibility ; if the coronet, the tendons and the fetlock are clean ; and 
if, on the other hand, the region of the small metacarpals is infiltrated or 
painful, splints are developing. 

When this growth is complete, and the bony inflammation has passed, 
the splint does not produce lameness, except in cases where, placed 
behind the principal metacarpal, it presses against the suspensory liga- 
ments and interferes with the play of tendons or the action of joints. 
" Splint does not produce lameness, but when it attacks the styloid bones 
or becomes so large that it presses against the tendons lodged between 
those bones," it does (Lafosse). "The callus running upward behind 
the knee lames the horse " (Solleysel). 

Against growing splints, several authors recommend cold baths, pressure, 
frictions of camphorated alcohol, embrocations of populeum, emollient 
poultices, repeated mercurial frictions. These means are little used, but 
the application on both faces of the metacarpus of a mercurial blister 
or of biodide of mercury ointment is preferable. The alcoholic solu- 
tion of sublimate, the ointment of bichromate of potash (Peuch, Lamour- 
oux), may also be used. There are cases where the bony inflammation 
disappears rapidly and where no exostosis is formed ; after a few weeks, 
the horse returns to work. In others the sensibility remains acute or 



EXOSTOSIS. 477 

the splint becomes more or less developed ; blistering preparations are nec- 
essary. 

Hammering with the back of the hammer of the plessimeter, followed 
by a blistering application, succeeds in a number of cases. The whole sur- 
face of the splint is hammered with light strokes, without bruising the 
skin, and then a blister put on. 

When, by blistering, one succeeds in reducing or removing the lameness, 
although the tumor remains, the animal may be returned to work. It is 
useless to try to obtain the resolution of the exostosis by firing ; as remarked 
Lagardere and Liard, it often resorbs spontaneously as the animal gets 
older. 

To obtain the " melting " of splints, massage and pressure have also 
been used (L. Lafosse, Moller). This is done by the application of a piece 
of sheet of lead or thick leather which is applied on the exostosis and held 
up by turns of rollers. Often, in a few weeks, the exostosis has diminished 
in a noticeable manner. The dressing is renevwed every day ; the skin, 
must be carefully watched to avoid the necrosis. 

If these means fail, cauterization must be resorted to — actual firing in 
lines, superficial or deep points. Notwithstanding the remarks of Liard, 
we use this last mode ; like Abadie and many others, we have obtained 
very good results with it. We puncture the skin through by one or two 
strokes of the instrument, and apply a stiff blister to complete the action 
of the firing. 

Periostotomy, recommended by Sewell, has been successful with Bouley, 
Haubner, Williams, Dammann, Ehlers. It must be performed aseptically, 
to avoid accidents by necrosis. During the eight days following there occurs 
a slight inflammation. According to Sewell, the animal can resume work 
eight or ten days after the operation; often the growth is resorbed' 
entirely. 

Ablation of splints is possible only for those that are projecting, pedun- 
culated, or situated far from the tendons. L. Lafosse has done it with 
chisel and hammer, " without having any accident to regret and without 
blemishes afterwards."' 

Median neurotomy may relieve splints that resist all those means of 
treatment and in which the lameness persists. 

English authors call sore-shin a peculiar affection of the cannon bone, 
which is common in race-horses. According to Cagny, it is specially fre- 
quent in colts of eighteen months to two years ; it is rare at three and 
absolutely exceptional in older animals. It always began during training. 
The excessive lameness that it gives rise to, when one leg only is affected ; 
the peculiar mode of standing of the subjects when both legs are suffering, 
may lead us astray in the diagnosis, and make believe to be navicular disease 



4/8 VETERINARY SURGICAL THERAPEUTICS. 

or acute laminitis. But soon there appears on the anterior face of the 
cannon a diffuse and painful tumefaction. 

The nature of this affection is still a subject of discussion. Williams, 
Cagny, Moller, believe it periostitis. Abadie has described it as " teno- 
sitis " of the extensors. Weber says it is due to a lesion of the extensors 
and of their sheath. 

Whatever may be its nature, the prognosis of the trouble is not serious. 
Treated at once by blistering application, everything disappears, leaving no 
mark. If, on the contrary, training is kept up, the symptoms increase ; a 
hard diffused tumor is formed on the anterior face of the cannon, which 
resists cauterization. Still, it does not seem to disturb the action of 
galloping (Cagny). 

Rest is the first indication of a rational treatment ; blistering does the 
rest. Seldom is firing required. Williams advises subcutaneous perios- 
totomy, which, for him, would diminish the duration of the lameness. In 
some cases where the opera,tion has been made with insufficient asepsy, 
periostitis has become suppurative and complicated with partial necrosis 
of the principal metacarpal. 

VI. — Ringbones — Sidebones — Phalangeal Exostosis. 

Under the name of ringbones are designated exostosis of the phalangeal 
regions. According to their location, they are divided into those of the 
paste7'n and those of the coronet. These are divided into phalangeal ' 
and cartilaginous.'^ Those exostosis present great interest from the 
surgical point of view ; as long as they develop, they give rise to lameness, 
which often lasts long, because the growth interferes with the action 
of tendons and ligaments, or presses painfully on the tissues of the foot. 

All the causes likely to give rise to producing osteo'-periostitis may bring 
on those exostosis ; among them particularly are efforts of locomotion 
which, through the stretchings of the ligaments, irritate the osteogenous 
coat ; violent reactions of the ground, dry arthritis, chronic inflammation 
of the peri-bony tissues, diffused exostosis of the pastern and coronet. 
After splits or fractures of the phalanges, or after the operation for deep nail 
in the fo'^t, they are frequently observed. Bony neoformations developed 
on a level with the insertion of ligaments, near the articular surfaces, 
sometimes spread and mingle together, surround the joint and bring on a 
false ankylosis. 

While ringbones are often seen on the hind legs, sidebones almost 
exclusively belong to forelegs. " Everyone knows the special affinity 
that fibro-cartilaginous tissue has for the elements of bone. As soon as 

1 Ringbones. ^ Sidebones. 



EXOSTOSIS. 479 

scutiform layers are inflamed, lime chalks are deposited in them, bony- 




Fig. loS. — Phalangeal Ringbone. 

degeneration takes place " (Bouley). Violent reactions, not proportioned 
to the resistance of the tissues, traumatisms, wounds on the coronet, car- 




Fig. 109. — Sidebones with atrophy of the third phalanx. 

tilaginous quittor treated by caustic injections, are as many causes of this 
ossification of fibro-cartilages. Among the other etiological influences 



.480 VETERINARY SURGICAL THERAPEUTICS. 

>Tnust be mentioned the bad formation of the foot, the vicious direction of 
the pastern, improper shoeing, heredity. Flat feet are much predisposed 
to sidebones. Tapon does not beUeve in the influence of heredity, 
mentioned by the majority of authors ; for him sidebones of colts are 
<iue to permanent stabulation. 

The diagnosis of these troubles, like that of splints, is often difficult at 
the beginning. All the lameness of youth are not due to periostitis of the 
cannon; there are those which have for causes phalangeal periostitis or 
incipient ossification of the cartilages, and sometimes a slight tumefaction 
of the pastern or coronet with an abnormal sensibility are scarcely detected 
by careful exploration. 

The prognosis varies much according to the size of the growth, its origin, 
its situation. If, in general, large exostosis produce stiffness or permanent 
lameness, there are many small ones which produce no pain, no func- 
tional disturbance. Periostosis produced by articular phlegmasias are, by 
the fact of the ankylosis which follows, extremely dangerous. In general, 
phalangeal exostosis which are limited, are specially serious when they are 
situated low, interest the horny box, are within it ; cartilaginous exostosis 
are so much more serious that they are more anterior. 

To pare the foot in such a manner that the standing of the digital 
region be firm and normal, apply a proper shoe (Coleman or bar shoe, 
according to the form of the foot), avoid excessive work, violent reactions on 
the pavement for young subjects, whose tissues are not yet fully developed ; 
laise the colts in liberty : such are the principal indications of the pro- 
phylaxis of those tumors. Turning out would often be followed by the 
resolution of incipient sidebones. Tapon says that he saw three colts, 
kept in stabulation, have exostosis in two weeks ; they were turned out ; 
they disappeared on one, diminished on another and remained in the 
third. 

The therapeutics of these diseases includes numerous methods among 
which a choice must be made. Often one is consulted at their beginning, 
when there exists only a little thickening, or an abnormal sensibility. Cold 
baths, continued irrigation, poultices, astringent applications, and rest 
sometimes give good results ; but blistering frictions are generally pre- 
ferred. They hasten the march of the disease and shorten the duration of 
the lameness. Ointment of bichromate of potassse has been beneficial with 
Toelen and Peuch. 

When the exostosis is formed, it is yet to alteratives that one must resort. 

If blisterings may relieve the lameness due to a young tumor, made of 

spongy vascular tissue, they are generally powerless with old, hard and 

■compact growths. Cauterization itself, though more powerful, is truly good 

.only against recent growths ; it is applied in lines, superficial or needle 



EXOSTOSIS. 481 

points. But it remains powerless with old, large or eburnated exostosis. 
To relieve sidebones, with firing are associated a proper shoeing and 
grooving of the foot (Weber). Lameness is partly due to the pressure of 
the tissues situated between the horny structure and the bony growth. 
To relieve the pains and help the dilatation of the posterior parts of the 
foot, division of the foot is resorted to. Ordinarily three grooves per- 
pendicular to the ground or slightly oblique downwards and backwards 
are made in the quarter, on the side where the growth exists. Another 
mode consists in making, one centimeter below the coronary band, an 
horizontal groove, from the heel to the anterior boundary of the sidebonej 
and two others converging slightly downwards : the superior has for object 
to permit the expansion of the coronary band. These grooves must not 
extend to the soft tissues, as they might bring on podophyllitis, necrosis, 
caries of the os pedis or a cartilaginous quittor. By daily applications of 
hoof ointment, tar or a dressing, the desiccation of the hoof and the 
formation of seams are prevented. Zundel, Humbert and others have 
recommended the thinning of the quarter with the drawing knife or the 
rasp ; the effects are the same on the painful region, the results are good. 
Sidebones producing contraction of the plantar region, special shoes 
indicated against this ailment shall be applied. In general, the bar shoe 
is recommended, with paring of the heels and relieving the quarter from 
pressure on the diseased side. The shoeing of Coleman-Poret is also very 
advantageous. As soon as the inflammatory phenomena due to cauteriza- 
tion have passed off, it is indicated to use the animal to slow walking 
exercise. By degrees the horny box spreads, the pressure diminishes, and 
the lameness may disappear notwithstanding the fact that the tumor re- 
mains. When the sidebone is very large, if one will not resort to 
neurotomy, a portion of the quarter can be extracted, extending from an 
oblique line made in a direction backwards and downwards from the 
coronary band a little in front of the sidebone. After a few weeks, the 
.animal is returned to work. The foot spreads below the exostosis, the 
new-formed quarter does not press as painfully as the old one ; the lame- 
ness diminishes and sometimes disappears. 

Extirpation is only practicable with sidebones and only in cases where 
the unossified part of the cartilage is affected with necrosis. Thin the 
quarter, isolate the coronary band on a level with the tumor as in the 
operation for quittor, cut it at its base with the narrow drawing knife, 
raise it, separate it from the tissues underneath, carefully avoiding the 
synovial cul-de-sac ; such are the various steps of the operation. Mangin 
has advised to divide the coronary band to operate more easily and to use 
a blunt bistouri to loosen the growth. The classic method is to be pre- 
ferred. 



^182 



VETERINARY SURGICAL THERAPEUTICS. 



.«*'-^ 



We will mention periostotomy only to proscribe it. It never gave but 
bad results. 

When ringbones and sidebones remain rebel to the treatments we have 
considered, neurotomy may be resorted to, to remove the lameness and 
render the animal useful. 

Low neurotomy — the division of the posterior branch of the plantar 
nerve — is not sufficient. The operation must be made above the fetlock, 
so as to destroy the sensibility below it. 

To perform the metacarpal ox metatarsal neurotomv, the animal is cast 
and the leg secured accord- 
ingly. If the operation is to 
be made on both sides, the in- 
side is operated first ; the animal 
being turned over to complete 
the operation on the other side. 
When the fetlock and the 
inferior part of the cannon are 
free from disease, the nerve is 
readily felt, alongside the lateral 
face of the tendons,a little above 
the fetlock. If the swelling 
prevent its detection, the line 
of the incision shall be made 
along the border of the cylin- 
drical mass formed by the ten- 
dons. The region prepared, 
the skin and cellular tissue are 
divided (2^-2 to 3 centimeters 
long) ; the nerve is isolated 
with the bistouri or the grooved 
director ; taken hold off with 
forceps, the bistouri is intro- 
duced underneath it with sharp edge turned upwards, and the nerve 
divided towards the superior extremity of the incision ; the free portion of 
the nerve is then amputated below. The wound is closed with one or two 
stitches, covered with collodion and a wadded dressing. 

Some horses, as soon as up, are free from lameness ; in others, this 
does not disappear except by degrees. When asepsy has been used there 
is no complication to fear ; cicatrization takes place rapidly. Sometimes 
the lameness is only reduced, which is due to the recurrent sensibil- 
ity or a stiffness of the articulations ; in these cases double or low neuro- 
tomy is indicated. It must be double where there are phalangeal peri- 




Fig, no. — High neurotomy, 
vein ; a, artery. 



n, nerve i y, 



EXOSTOSIS. 485 

ostosis or sidebones on both sides. The patient must be left to rest one 
month to six weeks, and the senseless foot must be watched for the 
traumatic lesions that may occur in it. If the foot affected with exostosis 
is the seat of acute symptoms, neurotomy is to be postponed until these 
have subsided. 

Renault in 1831 already mentioned the advantages of this neurotomy. 
Rey says he has used it often and obtained many satisfactory results with 
it (1867). Yet its use did not spread. It was accused of promoting soft- 
ening of tendons (Goubaux), producing slough of the foot. In 1881-83 
Nocard rehabilitated its use. He obtained many successes with it and never 
had an accident. Yet, he performed it on both sides, taking all necessary 
precaution ; such as : operate on legs free from acute inflammation of the 
feet, give the animal from five to six weeks of rest afterward, remove only 
a short piece of nerve, about one centimeter, so as to obtain as quick as 
possible nervous regeneration, which returns to the leg a portion of its 
sensibility. 

Many practitioners, Trasbot, Benjamin, Jacoulet among them, have 
been less fortunate. With them, high and double neurotomy has been 
followed with diffuse gangrenous inflammation and slough of the hoof. 
Even if performed on one side, it has not been entirely harmless. It is 
true, these accidents are exceptional ; and the fact must not be lost sight 
of that the operation is performed only on patients that have resisted 
all treatments and were useless. Therefore, notwithstanding the compli- 
cation of sloughings of the foot with which the operation is credited, 
we never have hesitation in performing it for large unilateral exostosis, 
rather than to lose time with useless cauterization. 

Let us add that contraction of the heels, which so frequently compli- 
cates the disease, often disappears after a few months, through the free 
function of the extremity. Nocard and Mollereau have shown that after 
the operation, the side of the exostosis sometimes diminishes in large pro- 
portions. In a horse treated by them, the bony tumor had, after six 
months, lost more than half its dimensions. 

High, single or double neurotomy, is not the only one that can be used, 
Peters, Goldmann, Blanchard have obtained good results with tnedian 
7ieurotomy. Sensibility is not abolished in the external half of the foot ; 
still, most commonly, lameness subsides. 

With phalangeal exostosis of the hind leg, high or again sciatic neu- 
rotomy is indicated, when firing has failed. 

These exostosis sometimes occur upon the anterior and lateral faces of 
the toes of cattle (Cruzel, Faulon). As in the horse, they are due to efforts 
or traumatisms. Generally they are only on one toe, and give rise to 
lameness, hence their seriousness. 



484 VETERINARY SURGICAL THERAPEUTICS. 

At first, cold applications are resorted to (continued irrigation, cold 
or astringent compresses). Later, blisterings, specially with the bichro- 
mate of potass (2 to 4 parts in 30), fine points of needles cauterization. 

Often, by simple change in shoeing, the lameness can be relieved and the 
animal be able to do his work or be fattened (Faulon). To this effect, the 
diseased toe is relieved from carrying weight ; the height of the hoof is 
reduced by paring it low, no shoe is put on that side ; while on the con- 
trary the hoof of the sound side is left untouched, and a pad of leather 
placed between it and the shoe. It is prudent to exercise the animal 
for some time on soft ground. In some cases, like Gutteridge, neurotomy 
has to be performed. 

VIII. 
RACHITISM. 

This expression must be reserved to name the softening of bones in young 
animals, and that of osteomalacia for the same alterations occurring in adults. 
These two morbid conditions seem to have similar causes and the differ- 
ences observed in the lesions depend invariably on the condition of de- 
velopment of the diseased bones ; in osteomalacia, the bone, already cal- 
cified, loses all its lime salts which are taken up by the circulation and 
eliminated, while the alterations in rachitism are the result of an insuf- 
iicient calcification. 

Relatively frequent in young dogs and pigs, rachitism is observed some- 
times in colts, calves, sheep, wild carnivora kept in captivity (lion, tiger), 
monkeys and gallinacious. The special conformation of the members of 
some species of dogs (the basset), considered by Daubenton as the result of 
rachitism, arrested in its progress and afterwards transmitted by heredity, is 
no longer considered as pathological, but as a character special to this 
breed. Yet rachitism is frequent in dogs, specially the Danish. Young 
pigs of improved breeds (English and other crossings) seem predisposed 
to it. Ordinarily the disease is manifested by general symptoms and 
local troubles. The alterations of bones vary much. On the extremi- 
ties, epiphysar swellings are observed, the bones are bent ; the front legs, 
deviated forwards, backwards, outwards or inwards, assume special aspect. 
The vertebral column may be curved upwards (cyphosis) or downwards 
(lordosis) or sideways (scoliosis). Bony growths are sometimes seen at 
the union of the ribs and their cartilage (rachitic bead) or on the sternum 
(chicken chest). The bones of the cranium present in some cases fon- 
tanels. In pigs and young goats, the maxillaries are swollen. The same 
occurs in horses. The case of Laquerriere, was that of a four years 
old horse, in which both jaws were affected. The little mare men- 
tioned by Soula was affected when three years old. The branches of 



RACHITISM 



485 



the lower maxillary had lost their consistency ; the superiors were swollen. 
Mastication was impossible, in a three-year-old mare seen by Benjamin 
:and Redon. 

The pathogeny of rachitism is yet obscure. L. Lafosse accuses bad 
hygienic conditions, damp habitations, those badly kept, exposed to the 
north where sunlight never goes. Feeding with fodder poor in calcareous 
substances has been incriminated. Guerin, Roloff, Voit, Chossat, 
Milne, Edwards, have produced it artificially in dogs and pigs, by sub- 
mitting them to a regime poor in lime salts. But Tripier and Weiske, 
who renewed the same experiments, failed in obtaining the same results. 
For some authors, Heitzmann among them, the rachitic bone is decalci- 
fied by lactic or phosphoric acid ; the administration of the first by the 
digestive canal and in subcutaneous injec- 
tions has produced the disease in young 
■carnivora (dogs and cats). The negative 
experiments of Toussaint and Tripier 
upset this theory. Is rachitism the result 
of an inflammation of the bone? and 
does phosphorus, recommended by Kas- 
sowitz, give rise really to a beneficial in- 
flammatory work ? Is there always, at the 
beginning of the disease, dilatation of 
the stomach and digestive troubles, as 
said by Comby? Those are as many 
unanswered questions of the day. Rach- 
itism is after all but the result of a unique 
cause ; it is the result of a " degeneration 
■with numerous causes." All that which 
Aveakens a young subject, that disturbs its 
nutrition, favors the softening of bone, 
in/asion of the disease occurs with the time of weaning ; hence the indi- 
cations not to deprive the young subjects too early of the mother's milk, 
which alone possesses the digestible qualities necessary to the stomach of 
the newly born. Potatoes in great quantity predispose pigs to rachitism. 
Roll has seen it in young lions fed with meat, free from bone. The same 
has been observed in dogs.^ " The too simple uniformity in food free 
from condiments, and specially want of outdoor exercise and natural light. 




Fig. Ill — Rachitic goat. (From a 
photograph.) 

Lafosse has remarked that the 



1 On two occasions, the translator had the opportunity to witness corroboration 
of the remark of Roll. A large litter of cubs being left to a lioness to nurse, the 
little fellows became rachitic after being weaned and being fed with boneless meat. 
Most of them died except two which were fed artificially with plenty of bone dust, 
but they remained always deformed, and more or less weak. 



486 VETERINARY SURGICAL THERAPEUTICS. 

seemed to have played a prominent part in several cases that I have 
observed in dogs and goats." (Trasbot.) 

The prophylaxy is indicated by the consideration of those etiological- 
conditions. The hygiene and the good quahty of the food should be 
watched. A diet as rich as possible should be prescribed. To palliate 
the insufficiency in the proportion of phosphate of lime, a greater quantity 
of grain should be given in each ration. If diarrhoea occurs, the ordinary 
treatment is indicated. 

The curative treatment is complicated. It is proper to prescribe the 
soluble preparations of lime, specially the chlorhydro-phosphate or the 
lacto-phosphate. In syrup shape, these preparations are given in doses 
of two or three tablespoons a day for a dog of middle size. As adjunct, 
bone dust, in two or three tablespoons according to cases, should be given. 
But Springer has shown that mineral substances, to be utilized by the 
organism, must be combined with the treatment. Phosphate of lime 
obtained from the mineral kingdom, as well as the phosphates of bones, 
can not be absorbed ; they can be found entire in the faeces. The 
author advises a decoction of cereals of which he gives the formula : 
Place in four litres of water, two tablespoonfuls of each of the following : 
wheat, oats, barley, rye, bran, corn ; boil them for three hours, filter and 
add water to make a litre. ^ This decoction may be used for all animals, 
specially for dogs. For herbivora it is better to give the grains in 
nature. Since Bretonneau, cod-liver oil has been recommended by nu- 
merous practitioners ; it is an analeptic tonic containing iodine and phos- 
phorus. In dogS; the dose is one or two tablespoonfuls a day. Kassowitz 
has recommended phosphorus (i milligram a day for dogs, i to 5 centi- 
grams for large size colts.) It could be given dissolved in sweet or cod- 
liver oil : 

Cod-liver oil 100 gramme. 

Phosphorus ........ i centigramme. 

All that can brace the appetite and stimulate nutrition must be used. 
Iron-tonics, quinine, gentian, are to be recommended. Salt is very good 
for sheep and calves. 

L. Lafosse advocated blistering applications upon the swelling of the 
head and irritating frictions (alcohol and spirits of turpentine) on the 
legs. To prevent the deformity of the bones of the legs, he also advised, 
at the beginning of the disease, the application of splints or plasters. The 
general treatment is far the most important. 

When improvement begins, the lame patient gets up more willingly and 
walkSjthe appetite returns ; the bones that were flexible, harden, but remaia 

^ Springer, Semaine Medicale, 1894, p. 393. 



OSTEOMALACIA — OSTEOCLASTIA — OSTEOPOROSIS. 487 

"tent; however, it frequently happens that aft^r a certain time, by regular 
exercise and good diet, the deviations of the bones disappear almost com- 
pletely. As soon as the bony nutrition is reestablished, at both extrem- 
ities of the bent diaphysis, the bone grows straight, the periostic ap- 
positions take place most exclusively in the concavity of the diaphysis, to 
such an extent that after complete development, the bone has a normal 
shape. 

When, on the contrary, a deformity remains upon one of the bones of 
the extremities, there is no hope to straighten it except by osteoclasia or 
osteotomy ; operations which will never enter in our surgery. What is 
difficult, is not to break up the bone — the osteoclasts of Colin and Robin 
answer that purpose (osteoclasia), — or to divide it with shears after inci- 
sion of the skin (osteotomy) ; but to keep them in good position. Our 
patients are restless, they constantly move and displace their dressings ; 
the regular union of the separated ends would be uncertain. Therefore, 
with them, the treatment of rachitism is almost exclusively medical. 

Rachitism is not very rare in birds kept in captivity or domesticity (Lar- 
cher, M^gnin.) It is observed specially in chickens, pheasants, turkeys, 
pigeons, ducks, geese and blackbirds. It appears ordinarily in the first 
months of life. Sometimes all the bones are affected, at others it is 
limited to a few, habitually to the bones of the trunk (vertebrae, ribs, 
rsternum, pelvis.) Life outside, strengthening diet, stimulating frictions of 
the legs (alcohol, hot wine), such is the treatment to follow. 

IX. 
OSTEOMALACIA— OSTEOCLASTIA— OSTEOPOROSIS. 

Some authors describe in special chapters osteo?naIacia, osieoclastia 
and osteoporosis. Osteomalacia, seen in horses, dogs, and goats, is 
characterized, as we have said, by the softening of bones in adult sub- 
jects. In osteoclastia, special to bovines, there is no softening, no de- 
formation of bones ; the spongy substance is partly resorbed and the med- 
ullary canal increased. Osteoporosis consists specially in a dilatation of 
the Haversian canals with resorption of the compact bony substance. 
•Germain has observed this affection upon our horses in Cochinchina, with 
an enzootic character. Most pathologists, with Friedberger and Frohner, 
make no difference in those affections ; they consider them only as mor- 
bid forms having causes of similar order, from which at last results an abnor- 
mal fragility of the bony tissue, due to the resorption of its spongy, of its 
•compact substance or of its calcareous salts. This fragility is principally 
observed in bovines (cachexia ossifraga.) 

The disease begins either by rheumatismal pains or by synovitis : these 



488 VETERINARY SURGICAL THERAPEUTICS. 

were frequently seen by Germ*ain. After a certain length of time, the 
maxillaries become thick ; the face is swollen, its normal shape gives place 
to a more or less marked enlargement. Respiration and specially masti- 
cation becomes difficult. The subject dies in a state of marasmus. The 
different bones of the legs do not present any malformation during the 
life of the animal. In cattle, the head is rarely affected ; the legs are, 
more commonly, and on that account the animal assumes the decubital 
position. With a capricious and diminished appetite, there is paresis of 
the hind legs, perhaps fractures of their bones may occur ; but it is excep- 
tional to meet with their softening or their deformation. 

The causes of these pathological conditions are about identical. A fact 
commonly noticed in bovines, is, that the disease attacks, ordinarily, ex- 
clusively cows in gestation or in full lactation ; which is attributed to the 
great deposition of lime salts demanded by the skeleton of the foetus 
and the production of milk. Males are almost never affected. Another 
fact, as common, is the localization of the affection to some countries. It 
is invariably in regions where the ground is poor in phosphate of lime 
that the disease occurs. Cantiget has published the analyses of various 
soils, which are very demonstrative : 



Nitrogen 

Phosphoric acid 

Potassia 

Lime 

Inquiries as to the quantity of phosphoric acid contained in hay grown 
on each of those soils gives the following result : 

I St. 2 kilog. 500 gr. of hay from a soil where cachexia is frequent give 
about 170 grams of ashes containing 2 grams p. 100 of phosphoric acid ; 

2d. The same quantity of hay from soil where the disease is rare, gives 
about the same quantity of ashes, but 2 gr. 70 and 29 gr. 80 p. 100 of 
phosphoric acid are found ; 

3d. From the soil free from the disease, there are less ashes (145 tO' 
150 grams), but those contain 3 gr. 85 p. 100 of phosphoric acid. 

These analyses, as well as the results of the intervention they have given 
rise to, show evidently that poverty of soil and hay in phosphates is the 
producing cause of bony cachexia. Hence, the indications to supply the 
soil with calcareous salts and specially with chemical manures rich in 
phosphates and superphosphates. The experiment needs no longer to 
be made ; it has been carried out by many practitioners, who all have seen 
the disease disappear. Youth, gestation, lactation are only predisposing 



il where cachexia 


Is at times 


Where it is 


does not exist. 


prevaiUng. 


frequent. 


7.184 


3076 to 2164 


3016 


4.048 


1280 to 1.32 


940 


14.688 


5100 to 5.032 


1.464 


245.952 


1.0752 to 2.5872 


9.148 



TUMORS. 489 

causes. Therefore, it seems possible to-day, by " treating " the soil alone, 
by furnishing it with the wanted phosphates, not only to prevent but to 
cure "cachexia ossifraga." Emigration to lands where the disease does 
not exist is also a means to obtain rapid recovery of the sick animals. 

The diet must be changed. Instead of fodders reaped on those poor 
soils, cereals, leguminous, such as oats, beans, peas, all the substances 
rich in lime salts, should be given. Oil-cakes are also to be recom- 
mended. By stopping the milking of cows so as to dry them ; and again 
by not having them covered, the consummation of phosphate of lime will 
be diminished ; but these are measures that can be only exceptionally 
applied. 

The medicamentous therapeutics, less important than the diet, must not, 
however, be neglected. Cod-liver oil (200 or 300 grams a day for cattle) 
is indicated, but its high price is an objection. Phosphorus in cakes of i to 
5 centigrams a day, dissolved in cod-liver oil, has been advocated by 
many and quite recently by Bass. Cereals, grains must be preferred to 
phosphate of lime or bone dust which are so often recommended (Springer.) 

Bitter and iron tonics (gentian, cinchona, water with rust of nails, etc.) 
stimulate the appetite and strengthen the animal. Local symptoms 
(articular swellings) should be treated by frictions of warm vinegar, cam- 
phorated alcohol, spirits of turpentine. 

In woman, castration has given encouraging results. It deserves trial 
in our large females, in the districts where osteoclastia exists. 

X. 

TUMORS. 

From the clinical point of view, it is advantageous to divide the tumors 
of bones into benignant and malignant, without distinction of the numerous 
groups established by pathological anatomy. Lipomas and myxomas of 
bones are almost unknown in animals. Fibromas (?) have been mentioned 
in the walls of the maxillary sinuses of horses and in the inferior maxillary 
of cattle (Zundel), Chondi-omas (enchondromas and perichondromas) 
are more interesting. Gurlt has seen them in the superior and inferior 
maxilliaries of horses, goats and dogs ; Roll in sheep and horses. Kiener 
and Peuch have published an interesting observation of osteoid chondroma. 
Perichondromas only justify extirpation. If they do not interfere much, 
it is better to leave them alone ; when they produce lameness, as in chon- 
dromas of the paws in dogs, they must be extirpated ; if the lesion extends 
deeply, in the thickness of the bone, amputation is indicated. In the case 
of Kiener and Peuch, after firing, the tumor developed on the inferior 



490 VETERINARY SURGICAL THERAPEUTICS. 

extremity of the radius, became as big as two fists, the leg swollen to the 
shoulder, the animal walked on three legs, dragging the other flexed. 
Notwithstanding amputation, the animal died. 

Most authors deny the existence of epithelial or p7-imiiive carcinoma- 
tous tumors of bones ; these neoplasms starting on a point where epithelial 
tissue exists, the bone is invaded only secondarily. In horses, on the 
bones of the face, epitheliomas are quite frequently seen which have for 
starting point vestiges of the epithelial dental structures inclosed in the 
superior maxillary. We will return later on to those tenebrating epithe- 
liomas. Myeloplax sarcomas are met as primitive tumors of bones, as 
shown by Megnin, Trasbot and our own observations. Developed on one 
bone of the leg, sarcoma deforms the region and gives rise to lameness. 
Sometimes the bony lever, unable to support the weight of the body, 
breaks under it. The only treatment likely to offer some chance of suc- 
cess is complete ablation of the tumor and amputation. When a tumor 
is developed on a claw of dogs or cats, disarticulation at the metacarpo- 
phalangeal joint may be followed by recovery ; but most ordinarily the 
metacarpal has also to be removed. Trasbot treated a greyhound in this 
manner successfully. 

Various tumors have been found in birds. Von Bibra has related the 
case of an exotic bird which had an enchondroma of the stinsum ; and 
Laborde one of osteofibroma in the claw of a chicken (Larcher). We 
have ourselves found osteo-sarcoma in chicken and pigeon. 

XL 

HYDATIDS. 

Only a very small number of observations have been published of echi- 
nococci of bojies in domestic animals : two in horses and seven in cattle 
(Neumann). In the case of Colin, observed in horse, " the hydatids formed 
in the sub lumbar region an enormous tumor which had invaded the 
muscles of that region ; it returned after two partial removals, one extended 
on the ilium ; echinococci were found in the diploea of the bones."' 

The therapeutics of these cases is poorly established. If the diagnosis 
was made and interference possible, the cystic cavity ought to freely opened 
and curetted. The vesicles are disseminated in the spongy tissue : it is 
very difficult to remove them all, and one overlooked is sufficient for a 
relapse. Scraping of the bone ought to be done as deep as the healthy 
tissue ; here, the best surgery is that which goes beyond the seat of the 
disease. The wound afterwards should be disinfected and covered with. 
an antiseptic dressing. 



CHAPTER XII. 

ARTICULATIONS. 

I. 

CONTUSIONS. 

The severity of contusions depends on the nature of the interested tissues, 
the intensity of action of the injuring agent, the thickness of the muscular 
layers which surround the joint. Ahvays a more or less active local in- 
flammation takes place in the skin and the tissues underneath ; it spreads 
sometimes deeply, as far as the ligaments, the synovial, the bones, when 
the contending agent has acted with great force. 

During the days that follow, the region swells, becomes painful, the 
motions of the joints are very painful, and the lameness is intense, if the 
articulation belongs to one of the extremities. 

For shght bruises, cooling applications (douches, astringents, compresses) 
■or resolutives (camphorated alcohol) and rest are sufficient : the inflam- 
matory symptoms soon subside. When the contusions are more severe, 
specially if the swelling is great, cold is good first. Later, warm baths, 
compressions, massage constitute the means of choice. For the superior 
joints of extremities, blisters are often used to insure immobilization of 
the joint. In some cases, the inflammation remains acute and the synovial 
membrane secretes with abundance ; the treatment must be that of closed 
arthritis. 

II. 

SPRAINS. 

This is a kind of incomplete and temporary luxation. Under the action 
of an excessive movement of flexion, extension, abduction or adduction, 
the articular surfaces are displaced and their means of union stretched ; 
but that only while the duration of the action of the cause lasts. 

The alterations produced are most variable as far as their severity 
goes; in mild cases, there has been only distension of the articular 
ligaments or rupture of some fibres ; quite often they as well as the 
synovial are partly torn ; it may happen that powerful funicular 
cords tear off with them the portion of bone upon which they are 

491 



492 VETERINARY SURGICAL THERAPEUTICS. 

attached ; the tendons, the muscles, are also partly or totally ruptured or 
displaced ; or there are cases where the diathrodial cartilages are- 
crushed on the opposite side to that where the ligaments have given 
way ; and, lastly, there is always a more or less abundant infiltration of 
blood, either in the peri-articular connective tissue or in the synovial 
itself. 

According to the seat of the principal lesions, sprains are divided 
into anterior^ posterior or lateral ; but after a few days, the inflamma- 
tion having spread all round the point, the anatomical diagnosis is often 
impossible. 

Generally, it is easy to distinguish a sprain from a dislocation or a 
fracture. However, for the shoulder and the hip, hesitation is per- 
mitted on account of the thickness of the muscular masses. 

The therapeutics of sprains has had many changes during the various 
epochs. In old farriery irritants were freely used ; on a sprained fet- 
lock, Solleysel applied its " emmiellure " (honey preparation) ; in 
sprained loins, these were covered with a coat of cantharides and pitch, 
half melted. Against recent sprains, Lafosse recommended bleedings 
and specially camphorated alcohol in frictions or cold water ; when 
there was large swelling, emollients first, resolutives afterwards, were 
recommended. In the days of the physiological doctrine, the inflamma- 
tion was treated by general and local bleeding, cold poultices (flax 
seed), emollient applications. The useless populeum was used in daily 
frictions; grease and oils were not neglected. Soon, however, observa-- 
tion showed the powerless effects of such treatments. Lameness, said 
Delorme, remained always during six weeks, two months, and even 
longer. Blisters, charges were then resorted to. It is yet to-day the 
therapeutics used by many; blistering, it is said, displaces the articular 
inflammation, brings it to the skin, immobilizing the joint at the same 
time by the soreness of the swelling it produces. 

A rational treatment must vary according to the time one is called to 
interfere. In the presence of a recent injury, one must try to reduce 
the inflammation and the swelling. It has been recommended to give 
the joints artificial movements (passive ?), with the object of replacing 
in their normal situation the parts which may have been displaced ; their 
usefulness is doubtful. Immobilization is much better. It is obtained 
by keeping the animal perfectly at rest, hobbling the front legs together, 
or applying an immovable bandage on the joint. (See Sprains of the 
Fetlocki) Compresses, dipped in ordinary or salt water, white lotion, 
camphorated alcohol, have their usefulness. To be efficacious, the 
cooling action must be continued, if possible, constant ; by this way 
reaction will be avoided. The applications of ice, recommended by 



SPRAINS. 495. 

?Bourrel, are good ; they require watching : kept on too long, they may- 
bring on sloughs of the skin. 

Of late years ffiassage and elastic compression are recommended. 

The excellent results obtained in man by massage are well known.. 
Choregraphy, specially, has been of great service in the treatment of 
spavins. But few years elapse without its doing wonders for some 
celebrated dancer. Forgue and Reclus mention the case of the " star " 
of the ballet of the Opera, who sprained her leg ; treated by massage, 
she was cured in two days.' In animals, the recovery by massage is 
not so rapid ; until now it has been but little used on account of their 
restlessness, the thickness of the skin, the abundance of the hair. It is 
made as we stated in the chapter on " Inflammation " : the hands 
smeared with vaseline or glycerine, apply, in the direction of the venous 
current, rubbings, slight at first, then more and more heavy as the 
soreness subsides. These manipulations are continued for five or ten 
minutes ; the clots of blood are crushed, the oedema is spread or easily 
resolved ; the swelling of the joint soon diminishes. The lower articu- 
lations of legs lend themselves well to those manipulations ; but the 
shoulder or the thigh cannot be massaged so easily on account of the 
muscles that cover them. When the rubbing is to be made against 
the direction of the hair, moderate massage will be performed by the 
application of a sheet of parchment over the region. 

Elastic pressure has also for effect to spread through the conjunctive 
tissues the exudated morbid products. With it is sometimes associated 
refrigeration : the diseased region is enveloped with oakum, an elastic 
roller put over it, and then continued irrigation is applied. 

Chronic sprains must be treated by stimulating frictions, blisters, firing, 
setons, irritating injections. Spirits of turpentine, ammonia, ammoniacal 
liniment, are often used, specially with cattle. If the blister is not 
applied by the veterinarian, he must be careful in marking with scissors 
the surface which is to be blistered. To neglect this simple precaution, 
is to expose one's self to have the blister improperly applied, and on parts 
which do not need it. With lasting lesions (indurations, periostosis), 
firing in lines, superficial or fine points are resorted to. 

With some sprains — those of the shoulder or the hip specially — 
setons count yet numerous advocates ; their beneficial action is princi- 
pally due to the immobilization they induce. Against muscular atro- 
phies irritating injections are useful, spirits of turpentine, watery 
saturated solution of salt, alcoholic solution of veratrine. 

In general, we treat sprains at the beginning by immovable bandages, 
pressure assisted with refrigeration, hot moisture or blisters. After 

' Forgue and Rectus : Therapeutique Chirurgicale, Vol. i, p. 50. 



494 VETERINARY SURGICAL THERAPEUTICS. 

ten or fifteen days we use douches or massage. If lameness is slow to 
disappear, if some induration remains, periostosis or hydarthrosis, we 
resort to firing. 

Sprains of Legs. 

/. — Sprain of the Scapulo-hu7?ieral— Effort of the Shoulders. 

For most of the practitioners and veterinarians of the first third of 
this century, sprains of the shoulder (entrouvertures) represented the 
greatest number of lameness of the anterior leg. In the Compte rejidu 
des travaux de V Ecole de Lyon for the year 1841-42, Rey mentions 
about one hundred and fifteen lamenesses of the shoulder ; but in this 
number certainly were included lameness due to lesions of other parts of 
the fore leg. Since the difficulty of the diagnosis of some recent osteitis 
is better known, specially since the frequency of the lesions of the 
navicular apparatus has been demonstrated, the number of sprains of 
the shoulder has considerably diminished. At the Alfort clinics, 
where cases of lameness are so abundant, we only see rare examples of it. 
How many old lamenesses with emaciation of the leg, and sometimes 
accompanied with a motion of abduction, accused of being located in 
the shoulder, have been relieved by neurotomy, proving they were not 
situated in the shoulder. 

Let us remember that Lafosse had justly insisted upon the rare presence 
of sprain of the shoulder and the frequency of foot lameness : " Many- 
stories have been made upon sprains . . . often it is said that the horse 
has a sprain, while the trouble is in the foot or on the lower articulations 
of the leg . . . For one horse lame in the shoulder, there are hundreds 
lame in the foot." ' 

However, the existence of those sprains is not doubtful in horses and 
cattle. Necroscopical lesions have demonstrated their lesions. Varying 
much in their nature and seriousness, they may involve the joint or the 
tissues surrounding. Muscles and tendons, playing the part of ligaments, 
which partly rupture under the influence of the traction they receive, are 
the most common. The researches of GauUet have proved the existence 
of the lesions of the pectoral muscles and of those of the internal face 
of the scapula. Peuch found in the sterno-trochineus and sterno-apon- 
euroticus tears with clots of blood on the road to regression. Rigot 
has often seen the partial rupture of the sub-scapularis. With the 
periarticular lesions, sometimes those of acute or chronic forms of 
arthritis also exist (Rigot and Renault). Sprain then is not characterized 
by univocal lesions: the lameness may be due to alterations of the 

1 Lafosse — Cours d' Hippiatrigue 1772 p. 24S. 



SPRAINS. 495. 

"various organs of the scapulo-humeral region. If the leg has been carried 
greatly in abduction, the sub-scapularis, sterno-trochineus and sterno- 
aponeuroticus have been stretched and more or less torn ; while ex- 
cessive adduction, flexion and extension produce respectively alterations 
in the abductors, the extensors, or the flexors. In the " disease of 
Williams " observed in horses used for plowing and which travel with 
one lateral biped higher than the other, there are lesions of some given 
muscles, of their tendons, of the articulation and sometimes of the 
nerves of the shoulder. 

To-day, as in the past, " knowing ones " always see in the shoulder the 
principal seat of lameness of the anterior leg; but careful examina- 
tion of the foot and of the lower regions of the leg generally permits the 
discovery of the true cause of the trouble. Many authors, Bouley par- 
ticularly for the horse, Cruzel for cattle, have insisted on that point. 
Lameness of the shoulder is more marked on soft than on hard ground ; 
the step is short, the leg carried forward with great difficulty and close 
to the ground. By palpation, there is ordinarily a soreness of the 
shoulder-joint detected ; one must always be guarded of the continual 
reactions of some animals. If the leg is raised by the hand and car- 
ried forward or backward, there is manifestation of pain ; the animal 
groans, is on the point of falling, but is unable to free himself; the pain- 
ful muscles of the shoulder contract little or not at all. The same 
manipulation practised on the other leg, by a sudden reaction the animal 
will free himself without trouble. 

Recent lesions, accompanied with pain and swelling, demand im- 
mobilization of the joint and antiphlogistics. Immovable dressings being 
difficult to apply in that region, hobbling of the forelegs is often re- 
sorted to. Advocated in 1650 by Beaugrand, then by Solleysel, Garsault, 
Bourgelat, this method was proscribed by Vitet, and specially by Lafosse, 
and then abandoned. Renovated by Delorme, it consists in applying 
hobbles on the pasterns, the common or the forearm, and securing them 
together. To obtain a more complete immobility of the lame joint, the 
animal may be tied to both sides of his stall by ropes. From time to 
time, the hobbles must be looked after, to avoid sores they might 
produce : it is rare when they are required more than a month. This 
method has given very good results to most of those who have used it ; 
applied from the start, it ordinarily answers for the most severe sprains. 
It is, however, indicated to employ cool applications, specially continued 
irrigation, astringents or irritating frictions. There are numerous 
preparations to select from : Delorme used camphorated alcohol or 
tincture of cantharides ; others prefer the charge of Lebas, simple: 
blister, mercurial or bi-iodine of mercury ointment. 



496 VETERINARY SURGICAL THERAPEUTICS. 

Such are the treatments to apply against recent sprains. But 
numerous patients are brought to us that are lame for some time, and 
when already the joint has received several applications of those liquid 
preparations which are so common to-day. Against those old lamenesses, 
numerous treatments are advocated. Setons, rowels, are yet to-day in 
great repute ; two, three, four are applied on the surface of the 
shoulder. The " monster " seton of Gaullet is not much used now ; 
it had no special efficacy, and was more dangerous than the other. If 
setons are applied, one should be placed in front of the shoulder, the other 
on the external face ; they should be about 20 centimeters long. The 
soreness that they produce helps in immobilizing the joint, they act also 
as derivatives and promote the resorption of exudated products (Bouley). 

Lines, deep pointed, subcutaneous cauterization, are the choice means 
against old sprains. Potential caustics (sulphate of copper, arsenic,subli- 
mate) used as trochiscus, have been recommended by some practitioners. 
Rey introduced under the skin, 2 gramms of sublimate corrosive and 
left them for 24 hours. " Fifty-three horses were submitted to this 
treatment, 35 for shoulder and 18 for hip lameness; all were cured, 
except three, two of which were lame for a very long time ; in the third 
the true nature of the affection was not positively located " ^ Statis- 
tics of this nature are not to be depended upon. 

Against " chronic sprains," subcutaneous injections of veratrine (i 
gramm. in 5 gramms of water) have been recommended ; they give rise 
to a local irritation which stimulates the muscular regeneration (Gerlach, 
Liibke, MoUer). Injections of ether and spirits of turpentine are too ir- 
ritating. Cruzel and Pages have used in cattle, subcutaneous in- 
jections of a concentrated solution of common salt : 25 cubic centi- 
metres in five injections envelopng the shoulder-joint. 

Let us now mention the means whose object is to produce in 
the injured structures forced movements which may stimulate organic 
changes. Old practitioners made the animal swim morning and even- 
ing for a quarter of an hour : they even obliged him to walk on the lame 
leg, by taking the sound leg off the weight of the body, either in placing 
a thick cork shoe on that foot or by raising the leg altogether and tying 
it to the forearm. 

The treatment of Luchow was more complicated. The shoulder was 
first rubbed with the following mixture : 



Liquor ammonia I gramms 
Spin of turpentm. ) -^ ° 
Camphor, alcoh. i g gramms 
Tmct. of soap ) ^ *' 



1 Rey — compte rendu des travaux de rEcole de Lyon. Rec. Med. Vet. 1S41. 



SPRAINS. 497 

then the animal, covered with double blanket and the neck well wrapped 
up, was exercised in circle, the lame leg outside, until the skin was cov- 
ered with perspiration. Taken to the stable, thick compresses, wet with 
cold water, and changed every two hours, were laid on the shoulder ; 
the last compress was placed in the evening and left on until the next 
morning, when it was taken off with the blankets. The next day the 
subject was walked for half an hour. Sometimes recovery was complete 
after two or three weeks. Hertwig and Delwart have tried this treat- 
ment with success. Nevertheless it is used but little. Cauterization, 
setons, irritating subcutaneous injections, completed by massage and 
a moderate exercise, are the classic treatments of old sprains of the 
shoulder. 

//. — Sprains of the K?iee. 

This is rare ; yet falls, slips, efforts, may produce it. Lameness, 
swelling, sensibility on pressure are sufficient for a diagnosis. Treat- 
ment is the same as in sprain of the fetlock. At first continued irriga- 
tion, plaster all round the joint, will relieve the inflammation ; after 
two weeks, massage and promenade exercise. Chronic sprain shall be 
treated by lines or pointed firing. 

///. — Sprains of the Coxo- Femoral — Allonge. 

For a long time all obscure lamenesses of the hind leg were considered 
as located in the hip joint ; but clinical observations and anatomical re- 
searches have shown the frequency of the lesions of the hock and the 
rarity of those of the hip. Examples of dry arthritis and of hydarthrosis 
of this joint have been related ; but the true coxo-femoral sprain is 
one of the rarest affections. How many times has the error been made 
of locating a lameness in the hip which was later on manifested by the 
appearance of a large spavin 1 The axiom of Bouley is always true : 
■" Out of one hundred cases of lameness of the hind leg, there are certainly 
ninety which come from the hock." And in doubtful cases, when all de- 
formity or increase of sensibility are wanting, when the diagnosis is 
uncertain, the surest way is to watch closely the hock and the foot. 

Although exceptional, sprain of the hip joint exists. Its therapeutics 
does not differ from that of shoulder injuries. Immobilization with hob- 
bles is good ; placed on the pasterns or the cannon, they keep the leg 
irom being carried forward and outward; they help recovery very much 
{Delorme). The animal will not be allowed to lie down, by being tied 
up ,to the rack or placed in slings. After two or three weeks short 
walks will be given. Irritants may be associated with immobilization ; 



498 VETERIx\ARY SURGICAL THERAPEUTICS. 

frictions are made on the thigh with camphorated alcohol, warm vinegar, 
spirits of turpentine, ammonia, etc., and renewed until the skin is get- 
ting covered with little scabs. The charge of Lebas, various liniments^ 
mercurial blisters, have a more powerful effect. 

Tape seton has been used, applied vertically on a level with the joint,, 
with a length of 40 centimeters ; some practitioners applied two or three, 
arranged in parallels. Rowell seton is a round piece of leather, which is- 
introduced under the skin over the diseased joint. Trochiscus (sulphate 
of copper, arsenic, sublimate) have been recommended ; the introductiori 
of 2 gramms of sublimate under the skin is highly spoken of. Arsen- 
ious acid gives a much larger slough than the sublimate. In our days 
lines and deep pointed firing are principally used. Subcutaneous cau- 
terization seems to have a more powerful action (de Nanzio, Lanzillotti- 
Buonsanti). The treatment of Luchow has been applied to sprains of 
the hip. 

The subcutaneous injections of spirits of turpentine, or saturated 
solution of common salt, recommended by some, are inferior to firing. 

IV. — Sprains of the Stifle. 

Sprains of the stifle and lacerations of the patellar ligaments are the se- 
quelae of either an external violence or of a powerful and sudden muscular 
contraction or of an excessive motion. The simple distention and par- 
tial rupture of these ligaments receive the treatment of ordinary sprains. 
On a horse treated by MoUer, the external ligament had been ruptured by 
the shaft of a wagon ; on another the same accident occurred in the stable 
at the time the animal got up. In both cases the lameness was very 
severe, the lame leg scarcely resting on the ground. The stifle region 
was very painful. Recovery was obtained in a month. The treatment 
consists principally in rest and blisters. In bovines, the ointment of 
bichromate of potassae is recommended. 

Voigtlander has seen a cow in which the three patellar ligaments were 
ruptured. The treatment of such lesions is not undertaken in large 
animals. For those of small species, the joint should be immobilized 
by immovable dressing. 

V. — Sprain of the Hock. 

This is quite common. Although the tibio-astragalian ginglymus per- 
mits only motion of flexion and extension, under the influence of vio- 
lent efforts, a slip or a jump, the lateral or the posterior ligaments of the 
tibio-tarsal articulation may be distended, strained, and sometimes the 
surfaces of insertion are subsequently inflamed. Often the tarsal spraia 



SPRAINS. 499 

IS the starting-point of spavin, jarde, or curb. This indicates that the 
prognosis varies according to the seat of the lesions ; but, in a general 
way, it is serious. 

At the onset, the treatment consists in rest, massage and douches, 
revulsive or blistering frictions. Later, if the trouble resists, cauteriza- 
tion is indicated. The treatment of rebel tarsal sprain is the same as 
that of spavin, jarde or curb. 

VI. — Sprain of the Fetlock. 

This is one of the most frequent sprains. The metacarpo or meta- 
tarso-phalangeal joint belongs to the class of the ginglymus, permitting 
only flexion and extension ; when it is flexed, it is scarcely possible to 
move it sideways. Any power able to give to that joint exaggerated 
movements of extension or flexion or likely to produce in it displacements 
incompatible with its structure, may produce a sprain. According to 
the localization of the lesions, sprains are divided into anterior, posterior^ 
lateral external and lateral internal. 

The anterior takes place ordinarily when the weight of the body is 
thrown on the joint flexed (as occurs frequently when the foot slips 
backward). On examining the leg, either raised or resting, a more or 
less marked sensibility of the anterior face of the fetlock and of the 
superior part of the pastern is detected, with also a slight swelling of 
those regions. The posterior sprain, due to violent and repeated 
efforts of locomotion, is characterized by alterations of the ligaments — 
tendinous apparatus of the posterior face. The lateral sprains have 
for principal causes mis-steps, slidings inwards or outwards. 

Wherever is the seat of the lesions, the local phenomena, especially 
the pain and tumefaction, indicate the trouble. Numerous and varied 
treatments have been proposed against it. Solleysel surrounded the joint, 
for two or three days, with compresses moistened with solution of sul- 
phate of zinc ; he preceded those with some frictions of alcohol or tur- 
pentine, and then applied his " emmiellure " (honey paste) with oakum 
and rollers. Other practitioners employed blisters. During the first part 
of this century, local bleedings, leeches, emollient poultices, populeum 
ointment, camphorated oil, and those of opium, belladonna, the friction 
with camphorated alcohol, white lotion, etc., were recommended. If 
these means have answered in many cases, they are powerless against 
sprains of some severity. Continued irrigation may give good results • 
to-day it is often used at the beginning of the disease. Compresses 
round the fetlock, frequently sprinkled with cold water, are excellent 
for mild cases. 



500 VETERINARY SURGICAL THERAPEUTICS. 

Delorme has recommended a method which consists in immobilizing 
the joint with an immovable dressing. Having mixed the white of ten 
eggs with thirty or sixty gramms of burnt alum, he impregnates three 
pads of oakum with it, and lays those all round the fetlock, A long 
roller is then applied over this, covered with the same sticking mixture, 
and rolled with a moderate pressure sufficient to obtain the immobiliza- 
tion of the joint. After a few hours, the bandage is dry ; the joint, in 
good position, is reduced to most complete rest. Generally, after a 
week, recovery is obtained. In some thirty cases, Delorme was obliged 
to renew his dressing only in two heavy and lymphatic subjects ; even 
with them recovery occurred, in two weeks. In a very serious case 
treated by Kopp, white lotion irrigations were made first and during 
the night ice round the joint. The fourth day, a bandage applied (150 
gramms of alum and white of six eggs) ; a week after, the horse had a 
free gait, and was very little lame in trotting. Many practitioners could, 
record the good results they have obtained with this treatment or others 
similar. When the bandage is removed after a week or ten days, often 
the pain has subsided, the swelling almost gone ; the joint has recovered 
its normal functions. And whether this bandage is applied immediately 
after the injury or some little time after, the results are excellent in 
most cases. Delorme relates the case of a mare which had been laid 
up for three weeks, the fetlock and tendon swollen, the rest of the foot 
very painful, the joint constantly flexed. He applied this dressing ; 
eight days after, all lameness had ceased ; it was taken off and another 
placed instead, which remained six days more, after which the horse 
resumed work. In the presence of very severe inflammatory symptoms, 
a slightly compressive bandage will be applied and constant irrigation 
followed for a few days. According to the author, "the powerful reper- 
cussion " produced by the alum, the contention of the diseased joint, 
•contribute equally to the success of the treatment. But it is certain 
that it is specially due to the close immobilization of the joint and the 
compression. A plastered apparatus would give the same results. 

Blisters and liniments have at all times been recommended. They 
will act as revulsive, " and with such rapid effect in most cases, that 
the removal of the inflammatory exudate seems to take place as if the 
bloody fluid accumulated in the capillaries of the inflamed synovial had 
been drawn towards the skin and fixed in its network." ^ By the in- 
flammation and the pain that they give rise to, they realize, like ban- 
dages, immobilization of the joint ; it is in this way that they are effica- 
cious. 

Whether coolings, blistering applications or immobilization have beea 

^ Bouley: Diet, of Med. and Chir. Vet., Vol. V., p. 358. 



SPRAINS. 501 

■used, it is good after ten or twelve days to resort to massage, with the 
hands smeared with a greasy substance ; rubbing over the region from 
upwards downwards, or, better, from downwards upwards, will scatter 
ever a wide surface the products exuded in the cellular tissue. Then 
the joint diminishes in size, the projections of the joint become more 
■■distinct, locomotion is less stiff. Morning and evening massage from 
five to ten minutes'will be given, and the articulation enveloped with 
oakum, and a roller moderately tight. 

At times some induration of the fetlock remains ; the synovial re- 
mains dropsical or exostosis may develop on the altered epiphysis. In 
such cases line, fire, or needle-point cauterization is indicated. 

Knuckling is a frequent complication of old sprains of the fetlock. 
In a three-year-old colt treated by Lardit, " the distension of the articu- 
lar ligaments and of the extensor tendons was such, that at the moment 
the anterior foreleg, the one affected, came to stand, the anterior part of 
the fetlock touched the ground." ' At the toe of the shoe of this horse 
was added a band, having the direction of the phalanges and which 
at its superior end was widened, padded and adapted to the forepart of 
the fetlock. Already, on the first day, the animal was able to walk, 
even trot ; he resumed work a little after. The orthosome of Brogniez 
might be used. 

Old sprains of the fetlock are generally complicated with periostosis. 
Median or sciatic neurotomy must be resorted to, to remove or diminish 
the lameness they produce. 

In bovines, the therapeutics of sprained fetlock differs little from what 
we have said already. Recovery is rapid in most cases (Furlanetto). 
After cold lotions for twelve or fifteen hours, Cruzel uses blistering 
frictions. 

Peuch recommends round the fetlock, three frictions, one day apart, 
with the following : 

Grams. 

Spir. of turpentine, ? -- 

Campor. alcohol, ( "^ 

Liq. ammonia, ) 

Tinct. cantharid, \ aa 20 

" of soap, ) 

Immobilization by bandage, massage, deserve attention also. Under 
the name of Big-foot {pied-gros) Festal has described a chronic sprain 
of the fetlock of bovines. The abnormal growth of the internal nail, 
pushing the fetlock outwards, produces, through the intermediate of 

1 Lardit: Journ. de Med. Vet. Theo. and Pract., 1S33, p. 380. 



502 VETERINARY SURGICAL THERAPEUTICS. ' 

: the external ligament, sprains on the bones, which result ultimately im 
periostosis of the fetlock, localized first on the outside, but gradually- 
spreading to the anterior region. The animal does not stand plumb 
any more, and the resting is made most exclusively on the outside of 
the external nail. 

Such serious lesions are incurable, and render the animal unfit for any 
work, but when treated early, they may be avoided. Festal says : The 
internal nail must be pared, a thick shoe should be placed on the outside 
toe, and at the same time friction, somewhat irritating, made over the 
coronary band to stimulate the growth of the hoof. Blisters and firing; 
have been used against the periostitis, almost always without success. 

VII. — Phalangeal Sj>rai?is. 

According to Percivall, these lesions are much more frequent than 
those of the fetlock. 6i cases counted by him show five of the 
metacarpo-phalangeal joint, 40 of the first phalangeal articulation, 16 of 
the foot. Some ten years ago, Vatel insisted on the frequency of the 
sprain of the first phalangeal joint. 

Many of these digital sprains give rise to symptoms which are not much 
marked ; at times there is local hj-perthermia, and motion is painful. 
Manipulations of the blacksmith in removing the shoe increase the lame- 
ness ; this is an important fact, says Vatel. 

Once the diagnosis is made, the first indication of treatment is rest, 
the animal loose in the field or a box stall. At the onset, cold baths or 
continued irrigations of the foot are to be recommended. Later, damp 
and warm compresses, blisterings. Immobilization with plastered or 
Delorme bandages gives also good results. 

If lameness continues, if specially the periostitis, which has taken place 
on the articular borders, promotes osteophytes and threatens ankylosis, 
firing must be resorted to. Too often, cauterization fails and high and 
double neurotomy has to be performed, or again the median or the 
sciatic. With very large periostosis of the fetlock and pasterns, these 
last operations will ordinarily produce sufficient improvement to permit 
work. 

The sprain of the re-enforcing sheath of the perforans and that of the 
posterior ligaments of the articulation of the coronet, are recognized 
from ordinary phalangeal sprains by the situation of the local phenom- 
ena (swelling and pain) to which they give rise, and which are located 
on the posterior and lateral regions of the pastern and of the coronet. 
When once diagnosed, it is recommended to shorten the toe of the foot, 
save the heels and apply a thick heeled shoe or one with high caulks. At 



SPRAINS, 503 

the beginning of the disease, cooling applications are used (cold baths, 
astringent compresses, continued irrigation) ; later, wet compresses or 
firing. In case of failure, neurotomy. (See Knuckling.) 

The digital region in working steers is frequently the seat of sprains; 
•ordinarily it is limited to one toe. It affects the articulations of the 
pastern with the coronoe, and of this one with the os pedis. During 
walking, the animal carries the leg in abduction if the lesion exists on 
the external toe, and in adduction if it is the internal which is diseased 
(Furlanetto). Cooling and immobilization at first, later blistering and 
firing, are the indications. Satisfactory results are rare. 

The inferior interdigital ligament, which in didactyles prevents the 
excessive separation of the toes, may be the seat of forced distensions. 
The animal must be left at rest, the toes bound together with bandages, 
-and cold baths given for several days. Recovery is ordinarily rapid. 

III. 

LUXATIONS. 

This term must be kept for the abnormal and permanent displace- 
ment of articular extremities. According to the degree of displacement 
luxations are co7fiplete when the articular surfaces have no longer any re- 
lation of contiguity and incofnpkte ^'\\en the osseous extremities are still in 
relation to a certain extent. They are also divided into traumatic, those 
that occur suddenly on a sound joint; consecutive, sytnptomatic o\: path- 
ological, those following an alteration pre-existing in the joint (dropsy, 
arthritis, tumors); co?igetiital luxations are those which occur during 
foetal life. These two last varieties are without importance for the 
practitioner ; they demand the killing of the animal. Alone, traumatic 
luxations are interesting from the therapeutical point of view. Due to 
direct or indirect cause, they occur under the influence of traumatisms, 
slips, falls, or even by muscular contraction. 

Such displacements do not take place without lesions, which sometimes 
are extensive ; the synovial is torn ; ligaments partly ruptured ; muscles 
stretched or torn ; cartilages bruised or crushed ; frequently a fragment 
of bone is torn away by a ligament or a tendon ; in some cases there 
is true fracture ; blood-vessels and peri-articular nerves are injured or 
torn. The communication of the synovial with the exterior and trau- 
matic arthritis are probable complications. 

Three indications are predominant in the treatment of luxation : ist, 
reduce it ; 2d, prevent its return ; 3d, attend the complications. 



504 VETERINARY SURGICAL THERAPEUTICS. 

The treatment varies as to whether the luxation is recent or old^ 
When it is treated before the appearance of the inflammatory phenomena, 
mild interference may sometimes succeed. The articular head has left 
its cavity in perforating the synovial; "through the opening it came 
out, it must re-enter." After having recognized the direction of the 
deviation, some few manipulations may be sufBcient to replace the 
separated surfaces in their normal position. If the manner in which 
the luxation has taken place is known with some certainty, the first 
step of the reduction consists in bringing the leg back to the position it 
occupied at the moment of the luxation. By methodical manipulations, 
special to each displacement, the head of a bone can be reintegrated 
in its cavity, and thus a complete return of the relations of the articular 
surfaces can be obtained, while the means of force often increase the 
lesions, produce a new tear in the synovial, or only have for result to 
push it back into the joint and squeeze it between the articular surfaces ; 
reduction is incomplete, return of the trouble almost certain. But if 
mild method, with or without narcosis, has failed, forcible process 
becomes obligatory. 

In small animals, the operator may perform the extensioti, counter exten- 
sion and coaptation alone. When operating on horses or cattle, assistants 
are necessary. It would be better to operate standing, so as to avoid 
violent efforts in getting up ; but it is generally necessary to cast the 
patient. To make counter-extension, ropes fixed on the upper region 
of the leg (round the axilla in the fore extremity, round the groin for 
the hind leg) are pulled upon by assistants, or tied to rings on the floor 
or posts. The cords used for extensions are fixed round the pastern or 
above the knee or the hock. The force necessary to overcome mus- 
cular contraction is sometimes enormous. To overcome it, the method 
of the continued pulling is recommended. Soon the muscles become 
relaxed and the reduction is possible. If this means fails, anaesthesia, 
which " leaves the peri-articular muscles without resistance," is to be 
resorted to. 

Pathological anatomy has revealed the changes which occur in a luxa- 
tion which has not been reduced. The old articulation disappears, 
the articular cavity is filled with fibrous tissue ; a true nearthrosis is 
formed round the displaced bony extremity, the surrounding tissues 
swell, adapt themselves to form pseudo-synovial and tendinous bands. 
A natural recovery takes place, but besides the fact that it goes on 
slowly, there always remains a lameness much marked. The twa 
steers mentioned by Cadiot were still very lame thirteen months 
after a coxo-femoral luxation left to itself. In the reduction of old 
luxations mild means do not succeed ; much force is to be used^ 



SPRAINS. 505, 

To reduce an old luxation of the humerus in man, Mayor had to 
employ twenty-one assistants ! Compare the strength of the muscles of 
man to that of the powerful masses surrounding the shoulder or the 
hip of our large species. Assistants are rarely pulling at the same 
time, the tractions are jerky ; for these reasons blocks and pulleys, which 
work steadily and regularly, had better be used. At first, the pull- 
ing is done in the present direction of the displaced bone, bringing it by 
degrees, as the leg is elongated, to its normal direction. During this 
step, the operator tries to obtain the coaptation ; and, as soon as the 
bones are on a level, he pushes them against each other, in the axis 
they ought to occupy normally ; ordinarily at that moment a special 
snap is heard, due to the meeting of the two articular extremities. The 
movements become possible, the joint resumes its normal aspect, the leg 
its natural length. The sudden change in the function of the extremity 
is striking. 

In studying special luxations we will see that each of them has spe- 
cial manipulations for its reduction. Those are sometimes very hard 
and long ; but by varying the direction of the tractions, in watching 
closely the coaptation, ordinarily the parts can be returned in their 
good position. Some cases occur when the attempts fail, and sub- 
cutaneous section of the fibrous strictures, or antiseptic arthrotomy has to 
be resorted to. Avoiding the blood vessels and the important nerves, the 
skin is divided, as well as the connective tissue, muscles, synovial ; the 
alterations are examined de visu ; the effused fluids are made to escape, 
the ligaments, which prevent the articular coaptation, are divided. This 
operation, which gives good results in man, has been partly successful 
in our hands on a dog suffering with an old luxation of the elbow. 

The reduction obtained, return of the luxation must be prevented. 
The means to employ differ little from those indicated for fractures. 
Wherever possible, immovable bandages form the method of choice ; 
they must always be resorted to on the extremities. In large animals, 
luxations of shoulder and of the hip are always difficult to hold reduced. 
With the first the iron splints of Bourgelat and the sticking mixture of 
Delwart are most recommended. Movements and decubitus are to be 
avoided ; hence the necessity to keep the patient in slings for some 
time. 

How long must the bandages stay in place ? Some authors advise to 
remove them after a few days ; others say not before six weeks or two 
months. Early movements predispose to return of the trouble, and to 
arthritis ; too long immobilization may bring on ankylosis and amyo- 
trophy. Not to count with the causes of failures, the bandage should 
be removed after two or three weeks, and the patient be allowed walk- 



506 VETERINARY SURGICAL THERAPEUTICS. 

ing exercise. Stimulating frictions, massage, exercise, shall prevent 
muscular atrophy and render the movements regular. 

Wounds constitute always a serious complication. Deep wounds 
which involve the traumatic center, ordinarily bring on arthritis and anky- 
losis ; however, these are not fatal. As for the superficial lesions, 
antisepsy permits their cicatrization without infectious accidents. 

Luxations complicated with fracture are, economically speaking, 
incurable in our large animals. In small species, the luxation should 
be reduced, and the fracture immobilized after its reduction. 

Luxation of Extremities. 
/. — Shoulder Joint. 

Protected by thick muscular layers, the scapulo-humeral articulation 
is rarely affected with luxation. It is complete or incomplete. Hurtsel, 
D'Arboval, Mathorez, Roloff, Hertwig, Seyler have reported cases in 
horses ; Matheron, Lodezzano, Bossetto and Seyler in cattle ; many 
have seen it in dogs. It is sometimes accompanied with fracture of the 
glenoid cavity (Rigot, Lavocat, Lafosse). In reading the published 
observations, one is convinced that the humeral head is generally lux- 
ated forward ; though luxations backwards, inwards and outwards are also 
observed. If it is sometimes difficult to detect the precise direction of the 
displacement, the symptoms are enough characterized to differentiate 
the luxation from a fracture, the only accident for which it may be 
mistaken. Sometimes, the animal has fallen forward, on the side, or 
when the leg was greatly in abduction ; at others, in a race, the leg has 
violently struck against an obstacle (Hertwig, Smith). The horse of 
the Observation I. of Seyler was mounted ; he stumbled and fell. 
When up, it was found that "there was no movement at the scapulo- 
humeral joint, the head of the humerus was protruding forward, and be- 
tween it and the glenoid cavity there was a wide depression." ' 

All authors consider this luxation an excessively serious lesion, on 
account of the difficulty of reduction and contention. 

Let us see how reduction must be made. According to Kaiser, 
nothing is easier with bovines. He says : Fix a rope at the fold of the 
pastern, carry the leg forward and upward until it can be secured to 
the horn of the same side and make the animal run. During this ex- 
ercise, the reduction takes place. Then make an irritating friction on 
the point of the shoulder. Bossetto recommends the following method : 

1 Seyler: Annales de Med. Vet., 1856, p. 564. 



SPRAINS. 5©i^ 

Cast the animal on the sound side, pass a rope at the pastern, and pull 
on the leg ; the operator with one hand holds this one steady, while 
with the other, it feels the relation of the articular surfaces. As soon 
as they can slip over each other, a strong pressure is made upon the 
humerus. 

The method of Seyler seems to us better. To pull the leg forward, 
backward, outward or inward, according to the displacement of the 
humerus ; then by methodical pressures made, push the head of the 
bone back in its cavity ; those are the requirements. In one case of 
luxation forward, '"'I had the head of the horse held by a man, another 
carried the leg forward, while a third pressed hard on the knee, the 
humerus being held in its normal position by a fourth ; I then gave a 
strong push to the head of the humerus with the palm of the right 
hand, and at once heard the very distinct snap of the bone re-entering 
its cavity." This method, which the author has used three times, has 
given him three successes. 

If, in operating this way, one does not succeed, it is necessary to cast 
the animal. But reduction standing is to be preferred, as there is always 
danger of disturbances by the efforts made in getting up. For this 
reason, Peuch advises to throw the animal with the belly-band of the 
sling, which afterwards helps to raise him. In the horse, muscular 
power is overcome by the use of chloroform. 

Most ordinarily, a peculiar noise indicates that the coaptation has 
taken place ; if it is not heard, the conformation of the joint, and the 
length of the leg, which have become normal, tell the surgeon the result 
obtained. 

The reduction made, next comes the contention. The iron splint of 
Bourgelat, " to fix the shoulders of a horse suffering with sprain," can 
be tried. (See Fracture of the Scapula.) 

Mathorez, after reducing the luxation in a horse, applied a blistering 
friction. Matheron, treating a calf, applied on the shoulder an iron 
sheet padded with oakum and secured with the surcingle. In the three 
cases he treated, Lodezzano applied a pitch' plaster. We have seen 
that Kaiser made on the region only simple irritating friction ; Bossetto 
placed on the point of the shoulder oakum dipped in vinegar water, 
which he kept in place by rollers. Seyler used the bandage of Delwart. 
(See Fractures^ He states that, as soon as the operation is ended, the 
horse, subject of his first observation, " held back in its ordinary position 
the leg which he had lost the use of, as if nothing had ever happened." 
In the case of Smith, immediately after the reduction, the horse walked 
easily, and was scarcely lame, eight days after. If the horse has to be 
thrown, he must be raised with a great deal of care. In all cases it is 



508 VETERINARY SURGICAL THERAPEUTICS. 

indicated to keep him for some time in slings to avoid the displacement 
of the bandage.. This generally drops off after some twenty days. 
There is no inconvenience in allowing the horse to take a little exercise ; 
relapse is not to be feared, and the best way to avoid ankylosis and 
amyotrophy is to make the joint work. Generally in a month or six 
weeks recovery is complete ; in few cases does it take longer. MoUer 
advises destroying, after ten or fifteen days, if there is no improvement. 
With small animals, recovery is generally easy. The reduction once 
operated, a pitched bandage is applied like that recommended by Del- 
wart for fractures of the scapula and of the humerus; 

//. — Hiwiero-Radio— Cubital Joint. 

Notwithstanding its powerful ligaments, luxation of this articula- 
tion can take place. A violent kick on the external face of the 
elbow may produce the lateral deviation of the articular surfaces 
(Peuch). A similar accident may follow a fall, when the leg is carried in 
abduction, in adduction, or if caught under a wheel (Lafosse, Soumille). 
The mule of Lapouse,^ loaded with three hectoliters of wheat, slipped 
and fell. On a first examination, the author remarked that the whole 
lower part of the left leg, from the elbow down, had a direction perpen- 
dicular to the median line of the body. " The superior extremity of 
the forearm was throw-n inwards and beyond the condyle of the 
humerus ; the lower extremity of this bone was resting on the external 
face of the superior extremity of the forearm and of the point of the 
olecranon." The horse treated by Decroix had a fall on the left side, the 
left leg bent under the ^houlder, between it and the ground. When the 
animal was up, it was observed that the forearm was oblique, forward 
and outward, while from the fetlock, the foot had a vertical direction. It 
was easy, by exploration, to observe the overlapping of the surfaces of the 
bones ; the articular head of the radius projected outwards and that of 
the humerus inwards. 

Lafosse and Soumille have published observations of luxations of 
the elbow in dogs. On the collie dog treated by Lafosse, the humeral 
trochlea was projecting oijtwards and the articular surface of the radius 
inwards. The subject cured by Soumille presented, at the external and 
superior face of the forearm, a large swelling formed by the extremity 
of the radius ; and on the internal face, a wound exposing the inner 
condyle of the humerus. 

The deformity of the articulation and the immobility of the surface. 

1 Lapouse : Journal des Veter. du Midi, 1S42, p. 180. 



SPRAINS. 509,- 

clearly demonstrate the accident. In small' animals, the reduction is . 
generally easy with recent luxation. In the dog of Lafosse, after a 
few seconds of traction, a snap was heard, and the reduction obtained, 
the dog arose, and ran with only slight lameness. No bandage was ap- 
plied. In a case of luxation with articular wound, Soumille obtained 
the reduction as easily, but the accident returned as soon as the animal 
moved its leg; a contentive bandage had to be applied. Seven days 
later, the dog used its leg; the bandage was removed ; the articulation 
was normal, no swelling nor deformity ; the wound, much contracted,^ 
did not allow the escape of synovia. 

If luxation is old, reduction is sometimes very difficult. We had to 
treat, in a pointer, a luxation of the elbow, mistaken for a fracture and 
immobilized for two months. Notwithstanding anesthesia and the help 
of several assistants, it was impossible to reduce it. Arthrotomy had 
to be performed from the internal face. The synovial open, a great 
quantity of reddish synovia escaped ; after partial section of the in- 
ternal lateral ligament, the radio-cubital articular surface, which had 
deviated outwards, resumed its normal position. The recovery from 
the operation was rapid, and the therapeutic result satisfactory. 

In large animals, though quite difficult, the manipulations are some- 
times less hard than they were expected to be. Lapouse had the head 
of his mule held firmly, while two assistants supported the animal on 
the right side. Placed back of the dislocated leg, he flexed the radius 
to carry the olecranon backwards, then applied his right knee on the 
internal face of this bone while pushing the lower extremity of the 
forearm inwards and the inferior end • of the humerus towards the 
thorax ; a snap was heard, the leg resumed its direction ; the animal 
could walk immediately. A friction of ammoniafcal liniment was made 
on the articulation. Nine days after, locomotion was normal, and 
the horse resumed his work. 

Decroix cast a horse and etherized him. Tractions made at the foot 
to bring the bones end to end failing (there was 6 centimeters short- 
ening), the cannon was flexed, then two ropes placed, one on the lower 
extremity of the humerus pulled upwards, the other on the superior 
part of the radius and drawn downwards, were given to assistants. In 
a few minutes, the luxation was reduced. The joint was covered with 
melted pitch and oakum cut in small pieces. Twenty days later, the 
horse went to work. 

To resume : in small animals, the reduction done early is easy, and 
the contention, during a few days, with bandaging, is enough to pre- 
vent relapse. In large animals, where the humero-radial joints demand 
great traction, anesthesia is a great help. To flex the forearm on the 



5IO VETERINARY SURGICAL THERAPEUTICS. 

arm, perform extension and counter-extension, practice opposite pres- 
sures on the osseous displaced surfaces, such are the requirements to 
fulfil ; once the reduction obtained, a pitch bandage or the mixture of 
Delwaft should be applied. To prevent displacements and the decubitus, 
the animal should be slung. After ten days there is no danger of relapse. 

///. — Knee Joint. 

Luxations of the knee are rare. Ordinarily complicated with fractures, 
tearing of ligaments and of tendons, recovery can scarcely be expected. 
The treatment must not be undertaken except for very valuable animals. 
In the American Veterinary Review^ Flynn has reported the case of an 
entire two years colt, which was found one morning stretched on the 
floor, cast with his halter, the right foreleg flexed and much swollen 
on the knee. On manipulating the leg. he could feel " the carpal bones 
dislocated outwards, near up to the head of the external small metacar- 
pal " ; the lower surfaces of the trapezium and trapezoid could be 
readily felt. By pressures made on the lateral faces of the joint, the 
reduction was obtained. A contentive bandage was applied. A few 
days after, the patient was placed in slings and treated by continued 
irrigation. Recovery took place without complication. 

IV. — Articulation of the Pelvis. 

The ileo-sacral luxation, very rare, is unilateral or bilateral. Walking 
is always painful ; there are at the croup abnormal movements, analogous 
to those of the sprains of the loins (Barreau). In general, the animal 
has great difficulty to get up ; paraplegia may be suspected. This 
accident brings on a deformity of the croup and a permanent lameness. 
After a difficult labor, the cow spoken of by Mollereau presented a 
great drooping of the sacrum in the pelvis : " the summit of the croup 
and the anterior borders of the ilium projected lo centimeters above 
the body of the lumbar vertebrae." According to Weber, similar accidents 
are not rare in difficult labor and produce paraplegia. 

Solipeds should be placed in slings, bovines left at liberty. Repeated 
blistering frictions should be made on the croup, or a pitch contentive 
bandage applied.' 

^ W. Dimond has recorded a case which occurred at the Hospital of the Amer- 
ican Veterinary College, of a horse which had been treated for sprain of the 
muscles of the loins and recovered, when a few days later he exhibited sj'mptoms 
of paraplegia, lameness of the near hind leg, lancinating pains, and later on 
manifestation of meningitis. The animal was destroyed. At the post-mortem 
there was found extensive bloody infiltration of the sublumbar region, a fracture 
of the last lumbar vertebrae, with laceration of the saro-iliac ligaments with, 
diseased condition of the articular surfaces. — Am. Vet. Review, Vol. 9, p. 127. 



SPRAINS. 511 

The luxation of the pubic symphysis, still rarer than the preceding, 
lias been observed only in bovines. In solipeds, where the ischio-pubic 
symphysis ossifies rapidly, a parasymphysar fracture occurs rather 
than the separation of the pubis and of the ischiums. Guy has related 
the case of a five-year-old mare which, annoyed by flies, slipped on the 
pavement, both hind legs in abduction. At post-mortem, with a com- 
minuted fracture of the bones of the pelvis, there was an ischio-pubic 
luxation. At the autopsy of a cow made by Golis, the ischio-pubic 
luxation coexisted with an ileo-sacral dislocation. This animal, like the 
heifer observed by Prietsch, which had a simple luxation of the sym- 
physis, was unable to get up or to stand up. 

The treatment consists in placing the animals in a quiet place, on a 
thick bed, and the lumbo-sacral region covered with a plaster of black 
pitch. Recovery takes place in two to four weeks; but there often 
remains a deformity of the croup and a weakness of the hindquarters. 

V. — Coxo-Fenwral Joint. 

For a long time, according to classical authors, the luxation of the hip- 
joint without fracture at the head of the femur was considered as im- 
possible. Rigot (1832) did not admit that the round ligament could be 
ruptured or stretched to permit the head of the femur to come out of the 
cotyloid cavity. For him " the force of resistance of this ligament was 
superior to that of cohesion of the femoral head : to such extent that 
efforts made upon the articulation were to fracture the bones rather than 
to have the ligaments give way and permit the luxation to take 
place." ' In relation to this accident, Dietrichs says : " Luxation of the 
coxo-femoral joint cannot take place in a horse except after rupture 
of the round ligament, accompanied with excessive stretching of the 
capsular ligament. And, unless by circumstances unknown to this day 
a fracture of the head of the femur or a part of the coxal occurs rather 
than the rupture of the round ligament.'"^ However, in 1840, Rigot 
in his Traite (f Anatomic acknowledged his error. 

Falke has related several cases of this luxation. In cadavers, he 
succeeded in producing it with a weight of 8 quintals in one case, of 16 
in another. Each time he saw the head of the femur and the cotyloid 
cavity intact, while the round and the capsular ligaments were torn. 
At the autopsy of a mule killed because of a luxation Gourdon found 
the head of the femur intact, entirely out of its cavity ; the ligament 
ruptured on a level with its attachment at the bottom of the cotyloid 
cavity, remaining adherent to the femur in all its length. At the ; 

^ Lafosse : Journal des Veter. du Midi, 1852, p. 57. 

2 Dietrichs : Lehrbuch der Chirurgie. 



512 VETERINARY SURGICAL THERAPEUTICS. 

Lyon clinic in 1854, one analogous observation was made in the 
horse ; here the coxo and pubio femoral ligaments were torn at their 
insertion on the femur. In an aged mule, used for surgical purposes, 
which had fallen with both hind legs carried in great abduction, the post- 
mortem revealed a complete luxation of the right hip ; both articular 
surfaces were intact, and the ligaments torn from the femoral head. 

These facts establish beyond a doubt the possibility of a luxation of 
the hip without fracture of the articular surfaces. However, in many 
cases, the accident is complicated either with fracture or with epiphysar 
separation of the head of the femur — in young animals (Arloing). In 
the observation that Goubaux communicated to the Societe centrale de 
Medecine Veterinaire (1875), ^""^ which related to an old femoral luxa- 
tion, the head of the femur was fractured, and nearly its two internal 
thirds had disappeared. The horse whose autopsy was made by 
Peteaux, presented a complete and longitudinal fracture of the neck of 
the femur; the internal half was held at the bottom of the cotyloid 
cavity by the coxo and pubio femoral ligaments almost intact. In the 
horse of Weber, a bony fragment from the head of the femur was loose, 
and one from the coxal was adherent to the superior extremity of the 
anterior straight muscle of the thigh. 

As complication of luxation, one may also meet with fracture of the 
trochanter or of one of the pelvic bones. The surrounding muscles are 
more or less lacerated. In the mule, just spoken of, there was a com- 
plete laceration of the vastus internus, at its femoral insertion ; and of 
the gemini of the pelvis near their middle, as well as laceration and 
partial ruptures of the psoas iliacus, internal and external obturator. 

However serious the accident may be, the symptoms are imme- 
diately well marked ; at rest, the standing takes place by the toe or the 
plantar surface ; in walking, the leg, deviated outwards, is carried all in 
one piece, with an abduction movement. The trochanter forms some- 
times a marked projection in external luxation ; it partly disappears in 
internal. The length of the leg is diminished or increased, according 
as the head of the femur is displaced upwards or downwards. It is 
generally possible to differentiate luxation from violent bruises or frac- 
tures. If the injury is lef^t to itself, the animal may die from exhaustion ; 
however, most ordinarily, the femoral head makes for itself a new cavity, 
walking becomes possible, but there always remains great lameness. 
Callot has observed two steers in which it was yet well marked thirteen 
months after the accident. Lafosse has registered cases of perfect 
recovery. He has seen, after nine months, emaciated muscles resume 
their normal size ; the direction and the action of the extremity were 
normal. 



SPRAINS. 513 

Reduction must be done with the animal cast and anaesthised. Coun- 
ter-extension is made with a rope, embracing the groin and with its 
ends attached to a fixed point. One or two ropes, placed above 
the hock and held by assistants, serve for the extension. The block 
and pulley permit more regular and steady pulling than assistants. The 
operation is difficult, and not without danger. A cow treated by 
Gamgee sustained a fracture of the neck of the femur. 

The manipulations vary according to the direction of the deviation. 
To this effect, one must recognize luxations in those that are forward, 
backwards, outward and inwards. Extension will be made in order to 
carry the leg in a direction favoring the return of the femoral head. 

The following are the methods used by the various authors who have 
written on the subject. 

In the case of Saussol and Ranson the luxation had taken place 
inwards. The horse was thrown on the opposite side, extension and 
counter-extension applied in the usual manner. Under the thigh 
a pail covered with straw was placed and pressure applied on the 
external and inferior part of the leg, so as to make a lever of the 
iirst kind. After a minute of traction, " presuming that the articular 
surfaces were in apposition, extension and counter-extension were sud- 
denly stopped, a sudden movement of the leg took place from back-- 
■wards upwards (in relation to the position of the animal from for- 
ward backward), accompanied by a noise analogous to that of two stones 
striking together. The luxation was reduced, and the animal able to exe- 
cute the ordinary motions of that extremity." ' In similar cases Lafosse 
advises to place a thick round object between both thighs and to push 
against the lower extremity of the dislocated leg. For a luxation out- 
wards, the same author recommends to throw the animal on the lame 
leg, to place a block near the trochanter, and to act on the lower 
extremity of the leg. By this process " he has operated successfully 
on two horses, a cow and several dogs." 

To reduce a luxation inwards of the left leg, Vautherin threw the mare 
on the right side. A rope fixed in the coronet and pulled upon by 
three men made the extension, the weight of the animal the counter- 
extension. " By carrying with force, the superior part of the leg from 
inwards outwards, the head of the femur could be brought in apposition 
with the cotyloid cavity, but a little back of it ; then by a strong and 
sudden pressure of both knees made by an assistant upon the projecting 
trochanter, at a second attempt^ the head of the femur re-entered its 
cavity, with the peculiar noise made by the striking of two articular sur- 
faces." 

' Saussol and Kanson : Rec. de Med. Vet., 1829, p. 223. 



514 VETERINARY SURGICAL THERAPEUTICS. 

Moller acts as follows : For luxation forwards (ilial luxations), once 
the leg is in extension, push the head of the femur from forward back- 
wards ; in luxations backwards (ischiatic luxations), carry the leg in ab- 
duction, then give it a quick, double motion of adduction and rotation 
outwards ; for luxations inwards (pubic luxations), similar manipula- 
tions with a greater abduction ; for luxations outwards (supra cotyloid 
luxations), carry the leg in extension and afterwards in adduction. 

Bossetto casts bovines, places them on their back, and has the dislo- 
cated leg, free from the hobble, carried backwards ; one hand rests 
upon the trochanter, and with the other the movements of the femur are 
regulated in order to make the head of the femur re-enter the cotyloid 
cavity. 

The reduction of an old luxation is rendered more difficult on 
account of new-made adhesions. Peuch could not obtain it in a dog 
whose injury was a month old. Anaesthesia would allow the contin- 
uation of the attempts at reduction ; but the adhesions become so 
strong that the traction will not let the articular head re-enter the 
cotyloid cavity already partly filled with bony neoformation. And in 
such case it is useless to perform open arthrotomy. It is better to leave 
well alone. 

To prevent relapse, Saussol and Ranson applied over the diseased 
part a coat of mustard and vinegar ; the animal was kept lying down ; 
the next day he was carefully raised with the slings ; recovery took 
place without trouble. With the same object, Vautherin applied a 
rowel, animated with blister ; after a month the mare was plowing ; the 
lameness disappeared entirely. 

If no complications occur, the animal can resume work after a few 
weeks. In the case of Furlanetto, the patient was turned out in ten 
days. 

VI. — Femoro-Tibial Joint. 

Luxations of this articulation are very rare. Some cases are reported 
in bovines. In the observation of Stolze, the tibia was dislocated for- 
ward ; the leg stiff and somewhat shortened. The luxation could be 
reduced, but returned almost as quick ; the animal was slung. The 
fifth reduction and the application of a stiff blister brought on re- 
covery. 

The cow mentioned by Hullot was lame on three legs ; the stifle 
joint was a little swollen. On its level " the tibia formed on the out- 
side a ressault, the width of the finger." The reduction, easy to make, 
was indicated by a sudden snap, but at the slightest movement of the 
animal, the tibia would resume its abnormal position. 



SPRAINS. 515 

Although the luxation is curable, it is one which ought not to be 
treated. 

VII. — Femoro-Patellar Articulation. 

The very great majority of observations described under the name of 
luxatiotis of the patella relates to the arrest of this bone upon the internal 
lips of the femoral trochlea, which acts there as a hook. However, it is 
not less established, by a certain number of facts, that the true luxation 
is met with. The special anatomical disposition of the stifle joint in 
bovines favors very much the appearance of this accident. The luxa- 
tion takes place specially outwards, but it is possible inwards, notwith- 
standing the elevation of the internal border of the femoral trochlea. 
Whether the result of a traumatism, of a slip backwards, of a violent 
contraction of the biceps cruralis or of a relaxation of the ligaments and 
muscles, it is always a serious accident. If reduction is easy, conten- 
tion is difficult. 

Having " a luxation inward of the left side " to treat in a mare, Perar- 
naud had the leg flexed by an assistant ; another steadied the stifle, 
Avhile a third pushed the animal slightly to the right. The author, 
placed on the right side and resting his right hand on the lower end of 
the patella, succeeded easily in replacing the bone in position. Rest 
and a friction of ammoniacal liniment brought on recovery. In a simi- 
lar circumstance, HuIIot, by pulling on the patella, was able to replace 
it easily, but the accident returned immediately. The cow was 
destroyed. 

In general, in cases of luxation of the patella, as in the pseudo-luxa- 
tion, it is advised to place a rope in the coronet, to pass it over the 
withers, then carry it between the forelegs backwards and hold the 
leg in complete extension. By pressure over the stifle in contrary 
direction to the displacement, the reduction is easy. The animal is tied 
up high in his stall and a blister applied over the whole joint. 

With congenital luxation Benard recommends a special means of 
contention. Take a band of linen, 12 or 15 centimeters wide, and long 
enough to go around the stifle region four times ; cut in its middle a 
window large enough to receive the patella; at 10 or 15 centimeters 
from the opening make a vertical slit. Apply the band in such a way 
that the patella be lodged in the central window ; pass one of the ends 
of the band through the vertical slit ; pull hard ; bring both ends of the 
bandage forward, crossing each other above and below the patella, and 
secure them. 

Kept in position for eight or ten days, the immovable bandage will 
prevent all relapse. (See Fseudo-Luxaiion of the Patella.) 



5l6 VETERINARY SURGICAL THERAPEUTICS. 

VIII. — luxation of the Fibula. 

Intimately fixed to the tibia by numerous short and strong fasiculi, it 
is rare for tlie fibula to be violently separated from the tibia. There 
are, however, some cases known. Behnke has published the case of a 
mare, which, after a jump, became suddenly lame on one hind leg; this 
was stiff and the standing impossible. These conditions lasted, and a 
big swelling took place on the superior part of the leg. The animal, of 
little value, was killed. At the post-mortem the fibula was found loose 
from the tibia and imbedded in the muscles of the leg. The inter- 
osseous ligaments had been torn. It is probable that the fibula could 
become immobilized in its abnormal position and the locomotion 
returns normal ; but recovery would take a long time. 

IX. — Hock Joint. 

Luxations of the hock are rare. Some observations are related 
in the horse by Louchard, Blavette, Rey, Gavard, Stockfleth, Haub- 
ner ; in cattle by Havemann ; in sheep, dogs and cats by Stock- 
jfleth. The anatomical character and the severity of the lesions 
vary. Sometimes there is luxation of the astragalus ; at others the dis- 
location takes place below it, between the lower bones or between 
the cuneiforms and the metatarsal. The dislocation, ordinarily incom- 
plete, is often accompanied with ligamentous and cutaneous lacer- 
ations, fractures or crushing of bones. Let us mention the observation 
of Rey : A horse, used to pull railroad cars, caught his left hind foot 
between a switch and a rail ; he was thrown. Raised, he cannot stand 
on the disabled leg ; the hock is seriously injured ; there is crepitation ; 
the animal is destroyed. At the post-mortem there was found a luxation 
of the hock between the two rows of the flat bones of the joints with lacer- 
ation of the external and interosseous ligaments, a rupture of the cord 
of the flexor metatarsi, a fracture of the large cuneiform and exter- 
nal metatarsal. Gavard has related a case of tibio-tarsal luxation. In 
a collision between two tramways, a horse was thrown down. When 
raised, at rest, there were but little or no symptoms ; but as soon as 
called to move the right posterior leg was not raised from the ground but 
■dragged forward. By exploration, a hard projection, formed by the 
extremity of the tibia, was felt on the inside. The horse was destroyed. 
" The tibia, violently raised and pushed inwards by the blow, had left 
the external border of the trochlea of the astragalus and was resting by 
its external groove on the internal border of the astragalus, forming 
inside by its second groove the prominence found during life. The. 



SPRAINS. 517 

external ligaments were irregularly torn from their insertion to the tibia. 
The capsule of the anterior face of the articulation was torn in its mid- 
dle. There was no motion possible in the articulation." ' 

All varieties of luxation of the hock are very serious. Recovery, 
when it is obtained, is always imperfect. On this account most animals 
suffering with it are destroyed. Schrader has published a recovery 
of luxation of the metatarsus in a cow ; Stockfleth, with a cat suffering 
withsubastragalean luxation, had success in reducing it and immobilizing 
the leg with an india-rubber band. In small species treatment might be 
imdertaken. By extension, counter-extension and manipulation applied 
in inverse direction upon the inferior extremity of the tibia and the 
superior of the metatarsus, the luxation might be reduced. A pitched 
or plastered bandage would insure immobilization. 

X. — Fetlock Joint. 

According to d'Arboval, metacarpo or metatarso-phalangeal luxations 
are frequent. With Peuch and Toussaint, we believe that they are rare. 
They occur in various circumstances, but their ordinary causes are those 
which, acting with less violence, give rise to sprain of the joint. Cases 
are related in solipeds and bovines. 

The lesions are sometimes extensive, and death may follow rapidly 
(Aureggio). On a horse seen by Lecoq, the inferior extremity of the 
metacarpal, which had perforated the skin, was exposed for a length of 
10 centimeters; the lateral ligaments were ruptured, the phalanges and 
the foot thrown backward and outward in such a manner that 
the foot was on a level with the lower end of the metacarpal. Same 
serious nature of the lesions on the patient of Romary : phalanges 
thrown backward of the metacarpal, which, having perforated the skin, 
came in contact with the foot. In the observation of Neumann the 

1 Gavard : Journal de Med. Veter. 1890, p. 410. 

Wray has recorded the case of a mare, which in a runaway accident 
had a complete luxation of the tibia and astragalus on the left hind leg, so that 
the tibia and metatarsus formed a complete right angle. The mare was 
secured, the luxation reduced, strong hickory splints and bandages were applied 
and the animal placed in slings, where she was kept for nearly a month, after 
■which she was discharged, apparently sound, with the exception of a slight 
swelling of the joint, which gradually disappeared. — Amer. Vet. Review, Vol. 
7, p. 20. 

Dr. Townsend has reported the case of a cow, which had also a luxation of 
the tibio-tarsal joint after a fall, in which the lower part of the leg was dislo- 
cated outwards and forwards. The luxation was reduced at once. The leg was 
bathed in warm water, and when the inflammation had subsided oil of tui^pen— 
tine was rubbed. The cow remained lame. — Amer. Vet. Review, Vol. 7, p. 75. 



5l8 VETERINARY SURGICAL THERAPEUTICS. 

Jthalanges formed with the metacarpus an obtuse angle open outwards ;; 
on the internal face of the fetlock there was a vertical wound, 15 
centimeters long, through which the lower extremity of the metacarpus 
protruded ; the ligaments were torn. Peuch has related a similar case. 

Luxation of the fetlock may occur sj^ontaneously or without violent 
effort. Cagny has seen a double luxation of both hind legs which 
occurred in that way. It was that of a thoroughbred stallion, " Veston," 
which, a few days before the accident, presented marked alternate lame- 
ness of both hind legs. Rheumatism was suspected, and treated with 
morphine, salicylate of soda, sulphate of quinine. One morning the 
horse was found lying down, the left hind fetlock dislocated. He tried 
to get up when a bandage was about to be applied on that leg, 
when the same accident occurred on the other fetlock. At the post- 
mortem, the tendons of the flexors and extensors were found normal ; 
the articular, synovial and lateral ligaments were lacerated. Another 
example of spontaneous luxation has been published by Magnin : the 
animal walked on the inferior extremity of his metatarsals. In cases of 
this kind, there is certainly inflammation or previous softening of those 
lateral ligaments. When the skin is torn, and the articular synovial 
open, and whether these lesions are due to violent efforts, falls, or occurred 
as in the cases of Cagny and of Magnin, in general, treatment must be 
given up. 

Fortunately the alterations are not always so complicated : for ex- 
amples, the cases of Granet, Barrier, Blaise, Smith, Wilhelm, Schellhase. 
With them, the skin was intact, the articular surfaces more or less 
displaced forwards, backwards, inwards or outwards. In the horse of 
Barrier, " the ossuffraginis, insteadof joining the metacarpal with an angle 
of about 145°, was thrown backward ; the articular surfaces were no 
longer in apposition, that of the metacarpal was resting on the anterior 
face of the suffraginis ; the lowered digital region formed almost a right 
angle with the cannon, and if, in those conditions, standing had been 
possible, it could not have taken place except by the posterior face of 
the phalanges and the heels." ' 

In the subject of Blaise, "the phalangeal region formed with the can- 
non an obtuse angle, whose opening corresponded to the external side 
of the leg ; the posterior face had become internal ; the foot, following 
the same rotatory motion, showed its plantar face ; on the inner side of 
, the leg, and on a level with the small metacarpal, the superior extremity 
of the suffraginis protruded under the skin." ' 

Whatever may be the direction of the deviation, if it is not too great,^ 

• Barrier: Journal des Veter. Milit., 1S70, p. 155. 
2 Blaise : Ibid., 1873-74, p. 419. 



SPRAINS. 519 

and if the joint is not open, there are cases where recovery may be 
looked for. Sometimes the reduction is easy. Blaise, with the right 
hand, took hold of the middle of the suffraginis, and, with the left hand, 
of the inferior extremity of the cannon ; he pulled strongly inwards upon 
the dislocated bones, felt a sudden jerk, and at the same time heard a 
snapping noise. The bones had resumed their respective position. 
Smith obtained the reduction as easily. Barrier threw his patient, 
placed two ropes on the cannon and one on the pastern ; this last was 
pulled in the direction to be resumed by the phalanges. " The leg thus 
prepared, a slow, continued and strong pressure was made with one hand 
on the posterior face of the fetlock, while the other, acting more parti- 
cularly on the pastern, brought about the relation of the articular surfaces, 
which was indicated by a marked snapping noise." 

To prevent relapse, the patient should be placed in slings and the fet- 
lock immobilized. Granet applied a contentive bandage of rollers and 
black pitch, mixed with spirit of lavender ; twenty-one days after, the 
animal resumed his work. Smith put on a shoe with two lateral vertical 
rods, having the direction of the lower end of the leg from the hock 
down to the foot ; to which, on a level with the fetlock, a concave metallic 
padded plate was attached. These metallic rods were held in place by 
straps. The treatment was completed by firing, and followed by recovery. 
The patient resumed work after a few months. During the first days, 
Barrier had recourse only to astringent cold lotions ; later, he fired the 
region. Blaise applied successively on the fetlock a friction of tincture 
of cantharides and an application of blister ; twenty-five days after the 
accident, the horse returned to his owner. Cagny has obtained good 
results with simple astringent applications. In the case of Wilhelm 
there was luxation inwards of one hind fetlock ; the horse was slung, 
the luxation reduced and kept in place with a solid bandage. In one 
of the observations of Schellhase (luxation outwards) the phalangeal 
region was perpendicular to the cannon, and there was, on the inner face 
of the fetlock, a large wound, through which the finger entered the joint. 
Treatment was, nevertheless, undertaken and the animal cured. 

Immovable bandages are to be preferred in most of cases. The iron 
splint of Bourgelat deserves mention. Made, of a metallic band, one 
centimeter thick, two and a half wide, having the shape of the leg from 
the superior part of the cannon to the heels of the foot, it is fixed on 
the shoe and held in place by straps. Relier's apparatus may also be 
useful. (See Fractures.) 

Let us mention here the case of Fourie, relating to a luxation out- 
wards of the external large sesamoid (left anterior leg), manifested by an 
intermittent lameness which resisted all treatment. 



520 VETERINARY SURGICAL THER4P^TTTTr<?. 

In bovines, luxation of the fetlock is rare. Few observations only 
Tiave been recorded. The three cases related by Strebel were heifers, 
aged from fifteen months to two years. Each time the injury consisted 
in an overlapping of the inside suffraginis on the metacarpal. The re- 
duction was performed standing or with the animal down. In these three 
cases, perfect recovery followed the application of a contentive band- 
age. 

XI. — Phalangeal Articulations. 

Luxations of phalanges are exceptional. United by strong ligaments 
and consolidated in their relation by very powerful tendons, phalanges 
are very little exposed to extensive and permanent displacements. 
Only very rare examples are published, all of the greatest severity. 
The case of Johne relates to a luxation of the third phalanx ; the lower 
extremity of the os coronse overlapped the small sesamoid backwards, 
the articular ligarrjents and the perforans were lacerated. 

If treatment is to be undertaken, reduction and immobilization are 
indicated, as for the other luxations. Bandages recommended for 
phalangeal fractures would be useful here. 

XII. — Pseiido luxation of the Patella. 

Solipeds and bovines are subject to a special and typical lameness 
of the hind leg, due to the patella becoming, so to speak, hooked by the 
summit of the femoral pulley. If the animal is made to walk ahead, 
the affected leg cannot be carried forward, but remains extended, 
obliquely downwards and backwards ; any flexion is impossible, and 
•when the animal moves, the anterior face of the hoof drags on the 
ground. Most minute exploration of the leg reveals only a slight 
tension of the muscles and a slight deviation of the patella outwards. 
These symptoms, however, disappear as rapidly as they occur ; it is not 
rare after a few minutes' walk, or even after a few seconds, to see the 
various joints of the leg flex upon each other, first spasmodically, as in 
stringhalt, and then normally. And ordinarily the return of the trouble 
takes place without apparent cause. 

These symptoms have received various interpretations. Solleysel,. 
Garsault, Lafosse, saw in them nothing but a " cramp " ; for Vitet, it was 
a temporary spasm accompanied with pains. Pastureau explained them 
by the arrest of the internal femoro-patellar ligament over the correspond- 
ing lip of the femoral trochlea. The great majority of authors have 
described this accident under the name of " luxation of the patella." But 
this last is very rare, and cannot occur without the laceration of one of 
the little femoropatellar ligaments. 



SPRAINS. 



521 



lit 



t;r.i 



Already in 1852, Meyer attributed the cramp of solipeds and bovines 
to tiie displacement upwards of the patella ; for him, this bone became 
fixed on the internal border of the femoral trochlea, where it was held 
by the internal and median tibio-patellar ligaments. It is the theory 
advocated by Bassi in Italy, Chuchu in France, and to-day admitted 
without discussion. The slight 
deviation of the patella is due, 
not to a luxation of that bone, 
but to the fact that the in- 
ternal border of the trochlea 
being higher and thicker than 
the external, the patella is 
somewhat thrown outwards. 

But how can the patella as- 
sume that position and keep 
it ? What power holds it there ? 
Practice teaches that this ac- 
cident is principally met with 
in colts, in animals recently 
put to work, in weak and 
anaemic subjects. It is thus 
that it manifests itself during 
the convalescence of some 
serious diseases (pneumonia, 
t3'phoid fever). A special 
conformation of the trochlea, 
specially of the kind of plate 
form which ends at its upper 
extremity ; the disappearance 
of the fatty cushions situated 
under the tibio-patellar liga- 
ments and above the trochlea, 
under the insertion of the triceps cruralis ; the violent or incoordinated 
contractions of the muscles ; the dry condition of the joint ; all those 
are the causes of the accident. 

The hooked condition is kept up by the stretching of the internal and 
middle tibio-patellar ligaments, of the first one principally. Violet has 
erroneously attributed it to a contraction of the patellar muscles. 

Submit the young subjects to a methodical training, and give a repair- 
ing diet to those weakened by serious or long disease ; such are the two 
principal prophylactic measures. 

The accident exists ; the patella must be returned to its place. A 




Fig. 112. — Stifle joint, l.i.t., internal border 
of the femoral trochlea ; t.r.i., internal 
patellar ligament ; f.r., internal femoro- 
patellar ligament. 



522 VETERINARY SURGICAL THERAPEUTICS. 

first method is to make the animal walk, holding his head high to pre- 
vent its falling, and, if necessary, urge him with the whip. Most ordi- 
narily after a few days the patella is unhooked and everything is in 
order. If walking fails, the animal must be made to back. If those do 
not succeed, apply a rope round the coronet, run it over the withers, have 
the leg carried in extension, and with the hand push the patella down- 
wards and inwards. Some prefer to practice this while the animal is 
down and securing the lame leg in the position indicated for castra- 
tion. 

In general, the luxation is easily reduced ; but, as we have said, re- 
lapses are frequent. Under the influence of methodical moderate work 
it returns only at intervals, sometimes further and further apart, and then 
disappears altogether. To hasten recovery, frequently repeated water 
douches can be prescribed, or blistering ; friction on the stifle and nutri- 
tious diet, the bandage of Bernard, the apparatus of Weber, to hold the 
patella in place, are little used. 

To overcome the " cramp of the vastus internus," Violet, after Tre- 
lut, advised the administration of one or two hundred gramms of cherry 
bark distilled water, diluted in honey and water. In rebel cases, to this 
antispasmodic treatment he associated blisters. 

When the pseudo-patellar luxation does not yield to those treatments, 
it is indicated to divide the internal tibio-patellar ligament, as recom- 
mended by Bossi. 

The modus operandi is simple. The animal thrown on the lame 
leg, the internal face of the stifle is exposed by carrying the opposite 
hind leg forwards, as in the operation of castration, or in fixing it on the 
corresponding fore leg, above the knee. The skin is shaved and asep- 
tized. The straight tenotome, held in a very oblique direction, is im- 
planted flatwise, back of the internal tibio-patellar ligament, immediately 
above the superior extremity of the tibia ; withdrawing it, the curved 
tenotome is introduced under the ligament, and this is divided subcuta- 
neously. The blood is wiped out and the wound closed with collodion. 

The adipose cushion, situated under the tibio-patellar ligaments, pro- 
tects the synovial from being injured with the instrument ; by dividing 
the ligament very little above the superior extremity of the tibia, where 
this adipose tissue is abundant, one will readily avoid the synovial sac. 
The result is immediate. The wound heals in a few days. 

This operation has given good results to Bassi, Falletti, Loy, Vach- 
etta, Guigas. With this last author, it was successful in a very old 

In the hospital records of the American Veterinary Hospital, Dr. J. Ryder 
reports the case of a stallion which was brought to the hospital for treatment 
of a luxation of the patella of several months standing. With great difl&culty 



WOUNDS. 523. 

case. We have performed it in an animal, on a case existing for a 
year. The success was complete. Our patient, " L'Orphelin," is to-day 
an excellent trotter. 

Vandenmaegdenberg places bovines on an inclined plane, the hind- 
quarter 30 or 40 centimeters higher than the anterior ; every hour cold 
water ablutions are made, and morning and evening frictions of cam- 
phorated alcohol with ammonia or spirits of turpentine. 

The operation of Bassi gives also good results in bovines. Savio has 
had four successes out of four cases. 

IV. 
WOUNDS. 

Among them we will consider : 

1 . Superficial or peri-articular wounds. 

2. Penetrating wounds, or with per/oration of the synovial sac. 

I. — Peri-articular Wounds. 

Frequent on the extremities, they offer, in their march and their prog- 
nosis, peculiarities due to the presence, in their neighborhood, of 
tendons, ligaments and tendinous burste — conditions which expose them 
to various complications. Fibrous tissues, poor in blood vessels, undergo 
necrosis easily if they are soaking in pus or invaded by an infectious 
process ; the extension of the inflammation to the synovial is possible. 
With well-managed antisepsy, those accidents may be avoided. If the 
wound has been made with a soiled instrument, it must be cleaned m 
all its parts with a strong antiseptic solution (sublimate 2 p. 1000, 
cresyl 5 p. 100, chloride of zinc 6-8 p. 100, alcoholic phenicated so- 
lution : alcohol 10 grammes, phenic acid i gramme); then apply a 

the luxation was reduced first, but, as soon as pressure over the patella was re- 
moved, the trouble would return. Warm fomentations and blister seemed to do 
some good at first, but after a few days the deformity returned and the horse was 
unable to use his leg. The case assuming a bad aspect, and the condition of 
the stallion getting worse. Dr. Liautard decided to try subcutaneous division of 
the anterior part of the biceps femoris, long vastus. At first this proved a 
failure. One morning the horse was lying down, when, suddenly frightened, 
he made a jump, and from that moment moved with perfect action. The re- 
covery was perfect. The author asks if it is an error to suppose that the div- 
ision of the muscle at the time of the operation was imperfect, but was com- 
pleted when the animal made a sudden jump after his fright ? In which case 
the propriety of such treatment in similar cases is indicated. — Amer. Vet. 
Hev., Vol. 8, p. 446. 



5^4 y^TERLNARy SURGICAL TJiERAP£UriCS. 

wadded dressing. It is important to have an immobilization of the 
joint as complete as possible. Every one knows how difficult it is 
sometimes to obtain the regular cicatrization of wounds situated at the 
fold of the hock or that of the knee. Absolute rest, enveloping of the 
leg from the foot to above the lesion with wadding, dressing with spUnts, 
slings, are very advantageous means. 

Large cicatrices on a level with an articulation interfere with their 
movements, hence the indication to reduce to the minimum the size of 
Avounds which may leave such blemishes, by sutures and properly ap- 
plied dressings. 

Cicatricial indurations, so frequent in front of the knee, stiffen the 
leg, render the footing less solid and predispose to new falls. The 
therapeutics of broken knees in horses must benefit by modern discoveries. 
Instead of the vulgar healers, careful disinfection and antiseptic dressings 
must be used. 

//. — Peiietratmg Wounds. 

Petietrating wounds of joints and traumatic arthritis shall be con- 
sidered separately. Not only is the opening of an articular synovial 
not necessarily followed by its inflammation, but, thanks to antisepsy, 
it can be avoided if interference is applied in time and properly. 
Serous membranes, like all other tissues, repair quickly in the center of 
wounds, providing they are protected from infection. The excessive 
severit}'^ of articular wounds is indeed not due to the lesion of the 
aponeurosis and tendons (Pare), nor to the resistance of the tissues to 
the inflammatory swelling (Brasdor, Eichat, Larrey), nor to the action 
of the exudate upon the synovial and the cartilages (David) ; it depends 
entirely on the inoculation of the wound, the infection of the synovial. 
Every day we see in horses, as well as other animals, the punctures of 
synovials, made aseptically with fine trocars, cicatrize rapidly by first 
intention. Here again, without contamination, no complication ; with- 
out germs, no suppuration. 

Sometimes the infection of the synovial is primitive, and results from 
the direct introduction of the injuring agent in the interior of the arti- 
cular cavity ; at others, it is secondary, consecutive to the suppuration 
or necrotic inflammation of the para-articular tissues. In this last case, 
the prognosis is most serious, as, ordinarily, when synovia escapes out- 
side, the serous is already deeply altered. 

At the onset, the symptoms are little accused ; a wide or a narrow 
■wound, allowing the escape of synovia, exists on one of the faces of the 
joint, locomotion remains regular, work can be kept up. But the in- 



WOUNDS. 525 

flammation is not slow in spreading through the joint ; this swells, be- 
comes verj' painful, the synovia which escapes is cloudy. Oftener, if 
the trauma is not attended to properly, after a lapse of time varying 
between two and six days, the practitioner has a traumatic arthritis to 
treat. 

That which must be prevented, is the inflammation of the synovial. 
We will see how this prophylaxy demands early aseptization of the 
■wound, followed with immobilization of the joint as complete as it can be 
.obtained. 

The severity of traumatic lesions of articulations is, in general, in pro- 
portion to the functional importance of those organs. However, the 
dimensions of the wound, its location on the anterior, posterior or 
lateral face of the joint, the extent of the peri- and intra-articular lesions, 
have much influence upon this severity. 

The researches of Rigot and of Goubaux have shown that articular, 
like tendinous, synovial sheaths are at times divided by partitions in 
several lodges, a fact which explains the localization of the infectious 
process to one part of the synovial, and the rapid recovery of some 
articular wounds and some recent arthritis. 

It has been said that articular lesions of the hind legs were ordinarily 
more serious than those of the anterior ; but the real differences ob- 
served on this point are more due to the anatomical complexity as well 
as to the more or less active function of the joints. A deep wound 
which involves a thick layer of peri-articular tissues is ordinarily more 
serious than the simple wound of a cul-de-sac. A wounding body which 
opens a joint, making in "the tissues that cover it a wound oblique 
downwards and inwards, gives rise to a more compromising injury, more 
exposed to intra-articular complications, than if it runs through the 
tissues in an inverse direction. We cannot insist too much on this 
point : what creates the danger, is the infection ; those are all the con- 
ditions likely to produce it or favor it. 

In the presence of an articulation which has just been opened, is it 
proper, by probing, to explore the wound to precise the diagnosis or 
recognize the exact condition of the alterations ? To-day, in human 
surgery, says Ch. Nelaton, " the exploration with an aseptic probe, or, 
better, with the finger, after enlarging the wound, is absolutely indi- 
cated." For our' patients, on account of the circumstances in which we 
are to realize asepsy, this practice would be dangerous. Although the 
synovial flow is not characteristic of the opening of the articulation — as 
it may result from a wound of the tendinous sheath — probing must be 
excluded. Nothing is more dangerous than to enter joints with dirty or 
suspicious probes, and explorations with an aseptic instrument which 



526 VETERINARY SURGICAL THERAPEUTICS. 

passes along the walls of a wound, made accidentally, is not always 
harmless ; the instrument may become infected in passing through the 
wound and inoculate the synovial. It is best to act as if the wound 
was of the most serious nature. How many times the curiosity of the 
practitioner has had for consequence the inflammation of a joint, which 
could, otherwise, have remained closed. 

The therapeutics of articular wounds and of traumatic arthritis has 
varied much with all epochs. In pre-antiseptic times, the great severity 
of those wounds has suggested against them the trial of the whole . 
medico- chirurgical arsenal. Most varying preparations have in turn 
been advocated and thrown aside. 

Old farriers were already divided on the question of the treat- 
ment of wounds of joints. Some, with Solleysel, used cauterization ; 
others, with Garsault, recommended emollients. 

In the years that followed the publication of the first veterinary 
journals, the physiological doctrine was at its best. To prevent or 
overcome inflammation, abundant bleedings were resorted to, and the 
patient submitted to severe diets ; the diseased joints were covered 
with decoctions of marshmallow, flax seed, or populeum ; simple poultices, 
or those associated with narcotics, were used. The wounds them- 
selves were dressed with tincture of aloes, diluted alcohol, camphor- 
ated paste. The advocates of the antiphlogistic method published 
their results, and Corroy, Auboyer, Pre'tot, made comments on the 
" lucky series." 

For Lecoq, the inflammatory symptoms ought to be treated first by 
emollients, then the joint be immobilized and'the wound dressed with a 
compressive bandage. He said : " I am inclined to consider the mech- 
anism of the cicatrization of synovial membranes as analogous to that 
which closes blood-vessels when their coats have been divided ; a por- 
tion of the blood coagulates in the opening, adheres to its borders, and 
in organizing, ends by becoming part of the divided coats. Com- 
pression, assisting the formation and the sojourn of the clot, must neces- 
sarily hasten the time of the cicatrization." ^ If antiphlogistic methods 
succeeded sometimes, the failures were numerous, and soon were used as 
objections to it (Renault, Tisserant) ; and again cases of spontaneous 
recoveries were recorded, in which nature had done all the work. Still, 
for a long time, poultices were kept in use. They reduce the pain, and 
were supposed to " prevent inflammation." We know to-day that their 
hot and moist atmosphere is, on the contrary, most favorable to py- 
ogenous microbes and to infection. 

As early as the beginning of this century, English veterinarians 

' Lecoq: Rec. de Med. Vet., 1S33, p. 416. 



WOUNDS. 527 

advocated cauterization of the external opening of the fistula, so as to 
produce a scab, preventing the flow of synovia, and assisting the cica- 
trization of the wound. This treatment was tried in France. Mercier 
and Desmoulieres did not hesitate, when treating at the beginning of 
the disease or in full period of inflammation, to thrust into the fistula 
an iron heated white. The results seemed encouraging. The observa- 
tions of Pauleau, Gerard, Pigeaire, Dubois, Faure, Eisele, had a tend- 
ency to show that deep and repeated cauterization could bring on 
recovery in cases where other treatments had failed. Renault called 
this method " rash and irrational " ; he admitted it only in extreme 
cases. The use of the red iron upon articular wounds gave rise to a 
disinfecting action which, in some cases, might be beneficial ; but it was 
rightly set aside for methods less incendiary. 

Tisserant remarked that emollients and cauterization of the fistulas 
gave only incomplete results. " There remain swellings of the diseased 
joint, indurations of the skin or of soft parts, enlargements of the 
articular extremities, often even exostosis. Against these, alteratives, 
resolutives, actual cautery, etc., are used, and the treatment is pro- 
longed beyond any expectation."^ The author recommended to abate 
the" inflammation by emollients, then to use blisters in repeated frictions 
round the joint. Instead of this last, pointed (Renault, Lecoq) or 
line cauterization could be used. Sometimes ten or fifteen days after 
the application of the blisters the animal could resume work. As de- 
rivatives, numerous preparations and agents have been proposed, from 
the most complicated topics to the simple sinapism. In a case of 
articular wound of the hock, Saussol, after a twisted suture, applied all 
over the joint " a coat of mustard diluted in vinegar ; twenty days 
after the animal resumed his work." Some authors attached great im- 
portance to internal treatment. Tartar emetic was much recommended ; 
Reboul advocated it as late as 1845. 

So as to obtain the closing of the synovial wound, every substance, 
which, by virtue of its chemical properties, was able to coagulate albu- 
men, was tried in turn. Burnt alum (Lecoq), alcohol and tincture of 
aloes, Rabel solution (Mercier), tannin (Causse), salts of lead (Mazzino), 
and sulphate of copper have been used with more or less success ; but 
it is no doubt sublimate corrosive that has the largest number of advo- 
cates. In a few years it supplanted all its rivals. Recommended by 
St. Cyr, then Dubois, Ollivier, Pierre, Dyer, Delorme, Romant, Payan, 
from the first days that it was used, it became acknowledged as one of 
the most efficacious drugs in the treatment of articular wounds. In a 

1 Tisserant: Journ. des Veter. du Midi, 1845, p. 145. 



528 VETERINARY SURGICAL THERAPEUTICS. 

superficial joint a pitched or turpentine pad was dusted over it, applied 
on the wound, where it was kept by bandages or adhesive strips. Some- 
times the synovial flow would stop, and when the dressing was taken off, 
after eight days, " the bottom of the wound was covered with a firm scab 
and recovery insured." If the obliteration was not complete a new plaster 
was reapplied. With deep wounds the fistulous tract was generally 
enlarged, as Schaack and Delorme did, and a lint, covered with the caus- 
tic, introduced in the fistula. Several authors, in particular Rey, have 
added blisters to that treatment. They were applied round the whole 
surface of the joint, with application of the sublimate over the wound. 

Barthe has tried to substitute nitrate of silver to sublimate. Bichloride 
of mercury sometimes acts too strongly and gives rise to slough of a 
large eschar, which increases the size of the wound, while nitrate of 
silver, less active, easier to handle, gives rise to a scab, rapidly elim- 
inated, without increase in the size of the external wound. Its use is 
very simple. The pencil is introduced in the fistula, where it melts 
slowly. It is good with large wounds to move it about to insure its 
action upon every part of the penetrating wound. Its application can 
be renewed several times, and at the same time the application of a blister 
can be resorted to. 

Collodion, simple or with sublimate, has been recommended, some 
twenty years ago, to obtain the closing of the wound. Michotte, having 
a deep wound of the stifle to treat, used first cool applications. The 
second day four grammes of sublimate were dissolved in thirty of collo- 
dion and applied in successive layers over the wound until formation of 
a stiff scab. Nine days after this was removed ; the wound was closed. 
Degive has also used the sublimated collodion with great success. 

Cold water has been recommended early, and is yet to-day used in 
large animals. Guilmot, Duvieusart,Sepulchre, Barreau, Sinoir, Causse, 
Eloire and many others have published observations in relation to the 
happy results they have obtained. For Trasbot (Archives 1877), " cold 
irrigations constitute the treatment par excellence of articular wounds." 
The flow in sheath is better than the strong current or the irrigation. As 
much as possible, the water shall have a temperature of 12 to 15 degrees. 
However, irrigation mu.^t not be left off, only when the temperature of 
the water is in the neighborhood of zero. When irrigation was experi- 
mented with at Alfort, students were made to apply it, changing every 
hour, night and day, and constantly showering the diseased part with a 
tube attached to a bucket placed full of water above the patient (Bouley). 
In the case of Barreau " irrigation was done by six men, alternatively 
pouring water over the wound with a syringe.'" Such methods had the 

^Barreau : Journ. de Med. Vet. Milit.,1862, p. 18. 



WOUNDS. 529> 

inconvenience to require too many assistants to apply it. They were 
not practicable. 

Irrigating apparatus have simplified the method. A reservoir, placed 
at 2.50m. from the ground, is fed with a watering pipe ; at its bottom a 
metallic cork is adjusted, provided with a rubber tube, of various lengths, 
and 7 to 8 millimeters in diameter. According to the cases, the free 
end of this tube is introduced in the wound, or its terminal extremity, 
perforated with holes made in its length, is twisted round the leg, above 
the diseased joint. The metallic cork may have two beaks and carry 
two tubes ; one to go round the joint, the other in the cavity. An ap- 
paratus for irrigation can be arranged anywhere by using a tub, a barrel or 
3.resQvvou ad hoc. As with many practitioners, continued irrigation has 
given us remarkable results. We have seen an enormous articular wound 
of the left hind fetlock, made by a ploughshare, healed in a month- 
The wound and the synovial were irrigated with a tepid solution of 
cresyl, 3 p. 100; for a few hours the articulation was enveloped with 
antiseptic compresses, then submitted to a constant stream of cold 
water. In five weeks recovery was perfect. A mare treated by Mauri 
had a contused wound of the anterior face of the left fore fetlock, with 
open joint ; after nine days the irrigation was stopped. " The synovial 
flow had stopped, the articular fistula was closed, and the wound entirely 
•covered with firm and healthy granulations." 

About i860, ^gyptiacum ointment, recommended by Verrier,^ became 
■" the favorite drug." In the treatment of articular wounds, this author 
\ised first bleeding, diets, poultices, emollients, soothing lotions. The 
pain reduced, he enlarged the fistula so as to be able to introduce his 
finger into it, and with it several times a day he pushed in it a certain 
•quantity of ointment, pure or diluted in oil. With this treatment, says 
Verrier, pains subside rapidly, standing improves, fistula contracts, syn- 
ovial flow becomes less abundant. Often after eight or ten days the 
fistula is cicatrized and the joint has recovered the complete freedom 
of its movements. Benjamin, Robert, Foelen, Royer, Salle, published 
good results obtained with it, and notwithstanding the failures of Raulet, 
Causse, Barreau, ^gyptiacum is classified amongst the best remedies. 

Glycerine, used alone or with blisters, and continued irrigation has 
been recommended by Aureggio. Injected in the fistula, " it shortens 
the period of congestion and the articular inflammation ; " it has given 
a number of successes "in desperate cases."'' But many practitioners 
have failed to find in it a superiority over the preceding methods. 

Camphor, quite in use some time ago in the treatment of articular 

1 Verrier: Bullet, de la Soc. Cent, de Med. Vet., 1858, p. 1042. 

2 Aureggio: Bullet, de la Soc. Cent, de Med. Vet., 1878. p. 290. 



530 VETERINARY SURGICAL THERAPEUTICS. 

wounds and then ignored, is yet employed in Belgium, in connection 
with antisepsy. 

Here is the therapeutic technic used by Hebrant, which gave him 95 
p. 100 of recoveries : 

Immediately after the accident, the injured region, after being well 
cleansed, is soaked in bran water. It is then disinfected in the most 
complete manner with phenicated water 5 p. 100, or Van Swieten solution, 
and then covered with a coat of camphor ointment (camphor and lard 
a. a.). 

" The horse is kept by himself, in a narrow stall, and submitted to a 
proper diet and nitrated drinks. The ointment is applied four or five 
times a day. After the first three days the strength of the ointment is 
reduced — i part of camphor for 2 of lard, i for 3, i for 4. The horse is 
not taken out of the stable as long as the treatment lasts. The great quan- 
tity of camphor spread over the whole region produces a continuous cool- 
ness, which prevents the inflammation of the joint ; the second or third 
day the region is swollen, the albumen of the synovia is coagulated, gran- 
Talations are stimulated, the fistula is soon obliterated. Besides this, cam- 
phor has antiseptic properties, that we re-enforce by the addition of phenic 
acid in the proportion of 5 p. 100." 

This, it seems to us, is an antiseptic method in which camphor does 
not play the principal part. To clean and disinfect the region with 
phenicated water at 5 p. 100, or with Van Swieten lotion, this is well ; 
but iodoform in powder, or iodoformed vaseline, would give just as good 
results, at least, as camphorated ointment. 

Among the treatments recommended of late, let us mention the 
envelopment of the region and the closing of the wound with a rubber 
roller (Petzold), with "clay" (Hoffmann), and the injection in the wound 
of an alcoholic tannic solution (Vigezzi). 

By this examination of the history of the therapeutics of articular 
wounds, it is seen that recoveries have been obtained with most varied 
means. But if comparison could be made between the successes and 
the numerous failures, the result would be of the darkest. Whatever 
has been said, most of those treatments would be powerless against 
penetrating traumas, if infected in their depth. 

The notions given by the pathogeny of the complications to which 
wounds are exposed impose the abandonment of the old methods for 
antisepsy. This must dominate the treatment of articular wounds. 

Pricks of articulations, in general, are less severe than large wounds, 
or those with loss of substance. Made under given rules, they 
are harmless. We will see that hydarthrosis can be punctured witk 
trocar with most complete impunity ; but for that we used instruments^ 



WOUNDS. 531 

of small size, clean and aseptic. It has been advised to enlarge the 
-wound, to open the synovial freely, to asepticize the articular cavity ; such 
interference seems to us harsh in animals, where the purification of the 
joint is always very difficult. We are satisfied with the disinfection of 
the trauma and its occlusion with a dressing or a collodion covering. 
Let us mention the observation of Michotte, relating to a wound of the 
stifle joint, which was in this manner covered with several coats of col- 
lodion and healed in a few days. The application of a sublimated 
plaster, after disinfection of the prick, and a peri-articular blistering 
friction, form a treatment deserving keeping ; the bichloride of mercury, 
deposited near the synovial wound, acts on it by its germicide action ; 
the blister brings on immobilization. The success obtained by Rey , 
Dyer, Delorme, has shown the value of this process. The essential is 
not to enclose infectious elements. Before being " barred," the wound 
must be carefully disinfected. As remarked Tisserant already in 1845, 
if obliteration is efficacious, " it is with the condition that the synovia 
shall remain identical to itself ; it is that the fluid, prevented from 
flowing by the clot, shall be, as the blood, normal and compatible 
with the regularity of the function; it is, at last, that no cause, external 
or internal, shall have modified the synovial secretion in its quality, 
so that the wound can be repaired regularly." ' 

To prevent the infection of the synovial, or to purify it in its soiled 
part and protect it afterwards from the germs: such is for large wounds ; 
as for pricks, what must be realized ? A careful antisepsy of the trauma^ 
by a free irrigation, shall be made ; by collodion covering and several 
bands of gauze, it will be protected, after being dusted with iodoform \ 
then the region shall be immobilized in wrapping it with a wadded 
apparatus, with or without plastered rollers, or again by a blistering 
friction (blister, bi-iodide of mercury ointment, alcoholic solution of 
sublimate i to 10). When the region does not permit the application 
of a dressing, blisters are used, specially with advantage for narrow 
articular wounds. The " derivative " action attributed to them is falla- 
cious, almost null in its " useful " effects ; but it can have a most bene- 
ficial influence in producing immobilization and closing of the wound. 

When the wound is very large, it can be reduced by a few stitches 
made towards its superior angle ; for some joints, drain tubes must be 
applied. With our wounded animals, total suture is dangerous ; if the 
asepsy of the superficial layers is not thorough, infected fluids spread tr> 
the synovial. It has succeeded, however, in many instances, Saussol 
has obtained a success by the twisted suture. 

1 Tisserant: Loco citate, p. I14. 



532 VETERINARY SURGICAL THERAPEUTICS. 

One of us has related a case of rapid recovery by antisepsy, of a very- 
serious wound of a hind fetlock. On the external face of this region, 
there existed a straight solution of continuity, lo centimeters long; the 
metacarpo-phalangeal synovial was widely open between the large 
sesamoids and the inferior extremity of the principal metatarsal. In 
separating the borders of the wound, we could see in front the metatar- 
sal and phalangeal articular surface's, and behind the anterior one of the 
great sesamoids. The peri-traumatic surface and the wound were 
disinfected, irrigated with Van Swieten solution, and an iodoform wadded 
dressing applied. This was removed seven days after ; under the gauze 
was found only a little reddish serosity ; the synovial was closed and 
the tissues covered with granulations. A new drjessing was applied. A 
month after, the wound was all healed. Treated with minute antisepsy, 
articular wounds would have no other march, if their purification could 
always be made perfect. 

Sometimes the wound is complicated with fracture of the articular 
extremities. Small splinters would not necessarily produce the fatal 
loss of a joint ; but there is always advantage to destroy the patient. 
Resections and amputations are not admissible in our therapeutics. The 
■cow with wooden leg which illustrates the cover of the Surgery of Hoff- 
mann will not tempt practitioners, and still less owners of animals. 
These operations shall be reserved for small animals. Conservative 
surgery is always to be preferred. By well directed antisepsy, dressings 
■well applied, septic accidents shall be conquered. Ankylosis is always 
better than amputation, on account of the accidents this last is exposed 
to, and the great difficulty presented by orthopedy in veterinary surgery. 
The gazelle amputated by Laligant for a metatarso-phalangeal arthritis, 
which died from the operation; would have lived with an ankylosed leg, 
if frequent cleansing injections had only been used. 

It remains for us to say a few words as to immobilization. Almost all 
authors have considered rest of the joint as a very favorable condition 
to the repair of the wound, and have advised it as much as it is possible. 
In 1873 Degive expressed doubts upon its efficacy. It was known that 
horses suffering with traumatic arthritis of the knee had perfectly 
recovered, although they were obliged to travel some distance (Servoles). 
In various cases, where immobilization had been neglected, recovery 
had taken place as rapidly as when the leg had been kept at rest. 
Degive asked himself, " if immobilization was really useful or prefer- 
able to free motion, to moderate mobility of the articular levers." For 
Maris, " immobilization is always useless in articular wounds, the animal 
fulfilling this indication himself." Laho and Thiernesse, on the contrary, 
continue to believe that this immobilization is one of the principal con- 



TRAUMATIC ARTHRITIS. 533 

ditions of success, and the great majority of authors are of the same 
opinion. 

To reduce inflammatory phenomena to their minimum, the patient 
should be placed in slings, unless he is too irritable. For lower articu- 
lations of the legs, wadded dressing gives a sufficient immobilization ; 
for the others, blistering should be used. 

Immobilization must not be kept too long ; one must take into con- 
sideration the stiffness of the joint and the peri-articular amyotrophies. 
As soon as the synovial wound is closed and pain is gone, massage and 
moderate exercise are the therapeutics of convalescence. 

As remarked by Tisserant, often recovery is not complete ; there 
remain lesions which necessitate the application of firing. With an- 
tisepsy, these consecutive alleviations are less frequent at present. 

We have had particularly in view the treatment of articular wounds of 
horses. For cattce and small animals, the indications are the same. In 
dogs, tepid repeated antiseptic baths have given us the best results ia 
cases of wounds of articulations of the extremities. 

V. 

TRAUMATIC ARTHRITIS. 

With soiled articular wounds in general, already the third, fourth or 
lifth day, the infection has spread into the joint : traumatic arthritis 
exists. 

The swollen, very painful, articulation is held in the position most 
favorable to the relief of its structure. If it be on a leg, the standing 
takes place on the toe ; there are frequent convulsive movements of the 
leg indicating lancinating pains ; a warm, oedematous swelling in- 
vades the surrounding regions or the whole leg ; there is an abundant 
flow of synovia scarcely of suspicious aspect or already purulent. 

As the infection process spreads, the symptoms are more marked : 
the most limited motions of the joint give rise to acute pains, that the 
animal avoids in remaining immobile, standing on its place or con- 
stantly lying down. Soon the swelling has become enormous. Through 
the fistula the escaping synovia is purulent, loaded with yellowish-white 
clots, exhaling a foetid odor. Fever is high,- the temperature going up to 
or above 40*'. The loss of flesh is more and more marked ; eschars, 
due to the long decubitus, appear on the prominent parts of the body. 
When the subjects resist, the articular cartilages are destroyed and the 
joint ankyloses. But this termination is not fatal ; by an energetic 
treatment started early, it can be avoided. 



534 VETERINARY SURGICAL THERAPEUTICS. 

In the preceding chapter, we have indicated the various therapeutic; 
means employed during this century to treat articular wounds and 
traumatic arthritis: bleeding, diet, emollients, dressings with tintcure of 
aloes, camphorated preparations, alum, tannin, sulphate of copper, blis- 
ters, caustics, firing, continued irrigation, aegyptiacum, glycerine, cau- 
terization of the fistula, lines or points cauterization. The greater 
part of these methods have been left aside. 

Antiseptic injections and blistering applications or continued irriga- 
tion remain the practical treatments to oppose to traumatic arthritis at its 
beginning. During recent years, facts have multiplied which demon- 
strate the superiority of antisepsy, for traumatic arthritis as well as for 
recent articular wounds. When the wounded synovial is the seat of an 
infectious inflammation, injections and antiseptic irrigations are far sup- 
erior to the methods or the agents of old therapeutics, not excepting 
caustics or aegyptiacum. 

If already the infectious lesions are deep, if the synovial is much 
thickened and granulating, if the cartilages are on the road to destruction, 
all hopes to save the joint its normal mobility must be banished. 
Nevertheless, antiseptics will diminish the general disturbance, conjure 
infectious and putrid infections and assist ankylosis — relatively for- 
tunate termination for certain categories of wounded (breeding or small 
animals.) They may do more, at the beginning of the articular phlo- 
gosis. The synovial alone is infected, sometimes only in a part of its 
extent, the synovia is but little modified in its properties, the cartilages 
are still with their normal polish ; recovery is possible. If a little stiff- 
ness and swelling of the joint remain, massage, blisters, or cauterization 
should be resorted to. 

One must not be afraid to enlarge a narrow wound, to permit injec- 
tions and washings to be made more easily, more complete and active. 
Mauri, Labat and others have related facts which show beyond doubt the 
beneficial action of sublimate. In the first case of Mauri, it was a mare, 
which, in falling, had opened her right fore fetlock. Ten days after, 
notwithstanding astringents and camphorated preparations, "the animal 
grew worse and worse. She moves with difficulty, on three legs, in her 
box ; she sufifers a great deal from her lame leg. The swelling of the 
joint is hot, exceedingly painful; the edges of the wound are swollen ; 
the synovial, reddish-yellow, escapes in abundance ; it coagulates in 
large clots on the anterior face of the first phalanx and exliales a pecu- 
liar, characteristic foetid odor. The swelling has spread to the lower 
part of the fetlock ; lymphatic cords starting from the diseased region 
extend towards the superior parts of the leg." A blister was ap- 
plied on the joint and injections of Van Swieten were made in the fistu- 



TRAUMATIC ARTHRITIS. 535 

lous tract. Seven days later, the synovial discharge had stopped, the 
fistula obliterated, the animal was gay. During a week, burnt alum 
was applied on the granulations to keep them under control. A few 
running water baths completed the recovery.' 

Immobilization is important. By means varying according to cases 
(wadded dressing with or without plastered bandage, blisters, hobbles, 
slings) the movements of the joint must be limited as much as possible. 

When arthritis runs its course, treatment is very long. Fistulas must 
he freely enlarged, abscesses punctured, irrigations abundant. Often 
the suppuration lasts for weeks, sometimes months, and numerous 
patients, exhausted by the pains, covered with bed-sores, succumb to the 
disease. 

For the study of the traumatic lesions of joints individuall}^ we have 
■not sepcLrs.ted the />eHetratwg wount^s horn art/in'ts. It would seem, a 
_priori, that in the three, four or five days following the opening of a 
synovial, this must be invaded by purulent phlegmasia, and quite 
numerous observations are found of rapid recovery in synovial wounds 
-of eight, ten and fifteen days ; on the other hand, the general phenom- 
•ena and the lameness are not absolutely characteristic of arthritis. 
The grouping of the observations would have been difficult, even arbi- 
trary, for many among them. To consider separately articular wounds, 
and in particular arthritis, would have been of no advantage in the prac- 
tical point of view. 

Articular Wounds and Traumatic Arthritis of Extremities. 
/. — Scapulo-Hunieral Jomt. 

Penetrating wounds of the scapulo-humeral joint are rare. For many- 
observations, positive diagnosis was not made, the lesions of the bicep>- 
ital groove not being distinguished from those of the joint itself. Rey 
has mentioned two cases where recovery was obtained with sublimate 
corrosive ; one was published by Schaack, the other by Pierre. This 
last author introduced in the wound a tent covered with populeum and 
dusted it with sublimate ; a second application two days after ; six days 
later, the synovia escaped no longer ; after six weeks the horse was 
cured. Romant, having a mule to treat which presented on the exter- 
nal face of the right shoulder-joint, a little back of the most prominent 
part of the angle of the shoulder, a deep transversal wound, with synovia 
escaping, covered the region with a blister, and applied a little subli- 
mate every day on the wound. After three days, a thick scab was 

• 1 Mauri— Rev. Vet., 1SS9, p. 62. 



536 VETERINARY SURGICAL THERAPEUTICS. 

formed, the synovia stopped running, the swelling and the lameness had 
disappeared. Fifteen days later, recovery was complete. With injec- 
tions of perchloride of iron, Leblanc stopped a synovial discharge of the 
shoulder in eight days. 

In our day, one must resort to antisepsy to prevent the infectioa 
of the joint. Called for a recent wound, the veterinarian should 
disinfect it with solution of sublimate, phenic acid or cresyl. If it is a 
prick, it will be closed with iodoformed or sublimated collodion. Large 
Avounds should be reduced by stitches on their upper angle and covered 
with iodoform or a plaster of sublimate. If already the infection is pro- 
duced, if the synovia runs purulent, by a free incision the joint must be 
opened and irrigations made with Van Swieten fluid. Most generally it 
is better to destroy the animal. As remarked by Mitaut, scapulo-hu- 
meral arthritis seems, indeed, to be one of the most severe of the ex- 
tremities. 

//. — Uumero-Radio- Cubital Joint. 

According to Percivall, penetrating wounds of the elbow must be 
classed among the most rebel. Rey says that they are those which 
have seemed to be most dangerous. Mitaut has never cured any. Still, 
some successes are recorded. 

Mercier has related the case of a horse suffering with a deep wound 
of the external face of the joint ; there existed a narrow fistula, with 
escape of synovia ; the wound was cauterized with the red iron, so as 
to form a superficial eschar ; recovery was obtained in two weeks. The 
patient of Pauleau presented alarming symptoms. After the prick of a 
fork in the elbow there occurred a large swelling, warm, very painful, 
and accompanied with high febrile reaction; a few days after a rough 
surface could be seen on the humerus and radius at the bottom of the 
■wound. The diseased bony surfaces were cauterized and frequent 
injections of tincture of aloes were made in the joint ; recovery took 
place after a long time. A few successes have been obtained by Tisser- 
ant with emollients and blisters ; by Rey with the red iron, and Rabel 
water ; by Delorme with sublimate. The first observation of Verrier re- 
lates to a penetrating wound of the elbow produced by a kick. The horse 
was very lame, a warm and painful swelling extending from the middle 
part of the arm to the elbow ; fever was high ; synovia escaped in clots, 
through the wound. During twenty-one days, emollients, tincture of 
aloes and cauterization were successively employed, all in vain. In 
two weeks, with aegyptiacum introduced three times a day in the fistula,, 
the synovial discharge was stopped and the lameness removed. Again 
with aegyptiacum, Salle obtained the recovery in a month, without blem- 



TRAUMATIC ARTHRITIS. 537 

ish or lameness, of an open elbow which had been treated for five 
weeks by blisterings and injections of all kinds. 

Continued irrigation has given a recovery to Trasbot. It was a 
horse which presented at the upper part of the forearm an oval wound 
measuring from five to six centimeters in its transversal diameter. This 
wound, oblique backwards and inwards, was ten or twelve centimeters 
deep, reached to the external side of the elbow joint. During four days 
cleaning and antiputrid injections were made, but the swelling of the 
joint became enormous and the discharge of synovia abundant. Digital 
exploration discovered the rupture of the external lateral ligament. An 
S probe was easily introduced in the articulation. A counter-opening 
was made about twelve centimeters back of the external wound, a drain 
tube introduced into the new tract made and continued irrigation 
started. Ten days after the synovial discharge had stopped, the fever 
subsided and the lameness gone. Hydrotherapy does not always 
succeed as well : we had two occasions to use it and two failures to 
record. 

When one is called to a recent penetrating wound of the elbow, and 
the local disorders do not impose the immediate condemnation of 
the patient, antisepsy is the treatment to choose. The wound and its 
surroundings shall be disinfected, and the clots of blood, the hair and 
foreign bodies removed ; it will be irrigated freely with tepid Van 
Swieten fluid, and covered with collodion coating and a wide wadded 
dressing, held in place by rollers crossed over the withers and in the 
axilla. Instead of this dressing, an application of blisters can be re- 
sorted to. 

If the wound is infected, there is but little chance of recovery. 
Wherever is the seat of the wound, injected fluids cannot penetrate deep 
enough, and disinfection of the joint is impossible. After free incision, 
it is again injections of tepid Van Swieten solution that must be used. 
When, after eight or ten days of treatment, the discharge of synovia is 
still purulent, the whole articulation is swollen and the general symp- 
toms aggravated, the animal ought to be destroyed. 

///. — Knee-joint. 

Traumatic lesions of carpal joints are almost always the result of falls 
on the anterior legs. In front and behind those joints, there are tendons 
provided with special synovial sheaths ; the escape of synovia, in wound 
of the knee, is not then a positive sign of the opening of the articular 
synovial. Penetrating wounds of the anterior face of the knee are less 
dangerous than those of the posterior. According to Trasbot, this dif- 



538 VETERINARY SURGICAL THERAPEUTICS. 

ference is due specially to the fact that the capsular ligament is more 
organized and apt to become vascular and granulate than ordinary fibrous 
tissue ; it is also on account of the greater anatomical complexity of the 
posterior carpal region. 

A great number of treatments have been used with success. In several 
cases of recent articular wounds antiphlogistic treatment has given good 
recoveries to Corroy and Auboyer. The animal treated by Corroy had 
fallen going down a hill, and after the accident had been obliged to 
travel, trotting or galloping, eight leagues. The synovial capsula was 
open in two places, the bones widely exposed. Recovery was obtained 
in eighteen days ; the lameness disappeared entirely. With Pressecq, 
other practitioners added to that treatment the cauterization of the bones 
exposed. Coagulating agents and caustics have been recommended : 
Mercier has related two cases of recovery with Rabel water ; Causse 
twenty-two with tannin ; Guilmot a few with starched bandage ; Mazzini 
five with plastered dressings ; Key two with sublimate. Nitrate of silver 
has often succeeded with Barthe. Mitaut has recommended blistering 
applications on the diseased joint ; Cagnat, slight and repeated cauteriza- 
tion of the wound with caustic tar. 

Verrier has had several successes with aegyptiacum. His case of 
Observation IV was a fearfully broken knee ; the wound involved the 
skin, the cellular tissue, tendons, capsular ligament and the anterior part 
of the carpal bones ; there was high fever and great pain. After 
bleeding and emollient poultices, sprinkled with decoction of poppy 
heads, which gave no results, aegyptiacum was used : in ten days the 
recovery was certain. There remained but a superficial wound, and the 
lameness had disappeared. The same result was obtained with Observa- 
tion V. The horse treated by Robert was in the worst condition, when 
aegyptiacum was resorted to : recovery was rapid. Royer and other 
military veterinarians have published similar results. 

Although cold water in continued irrigation is a practical means, highly 
recommended, immobilization should be preferred to it under a wadded 
iodoform dressing. The wound ordinarily contains gravel, earth ; the 
tissues are bruised and ragged : wash with boiled water, then a strong 
antiseptic solution, apply a coat of iodoform and a wadded dressing. 

With padded splints or frames applied upon the lateral and posterior 
faces of the knee, it is easy to bind, in a great measure, the movements 
of the joint. Already Mercier had recommended immobilization. " Take 
five strong laths, cut them the length of the leg, apply four straps with 
buckles on one of their faces at even distances, wrap the laths with 
oakum and lay the apparatus round the injured region. With one of 
those bandages, the leg is kept constantly in extension and the joint in 



TRAUMATIC ARTHRITIS. 539 

immobility." ' Three padded splints can be applied, extending from 
the middle of the forearm to that of the cannon, being held in place by 
dextrined rollers or straps with buckles. A blister upon the lateral face 
of the hock is also a simple and useful means of immobilization. 

When suppurative inflammation has invaded the articular synovial, 
the " game must not be considered as lost," as Barreau did, although 
the prognosis is most serious. Instead of any of the treatments pro- 
posed, antisepsis and blisterings will be preferred. Subjects of little 
value should be destroyed. 

Sometimes the knee remains large, wrinkled, and a lameness remains, 
varying in its severity : cauterization must be used, or median neuro- 
tomy. 

/ V. — Fevioro-Tibio-PatcIIar Joint. 

Deep wounds of this articulation are common. According to Rey, 
they are the most frequent of all articular wounds observed among 
solipeds ; they are also the least serious. Treated early, when the synovia 
is not yet purulent or the infection of the synovial is neither diffused or 
deep, they ordinarily close rapidly. Often a blister has been sufficient 
to obtain a recovery, as shown by the observations of Tisserant, Delorme 
and Rey. Out of twenty horses treated by Rey, eighteen were cured 
by blister and one by sublimate ; only one died. And yet the symptoms 
seemed at times very serious. The mare of Observation II had re- 
ceived, eight days before, a kick on the external face of the thigh ; a 
large swelling had formed, which had been punctured. When Rey saw 
the patient, the articulation was hot, painful, the swelling extended down 
to the hock, the synovial discharge was abundant. Two frictions of 
blisters were made, twenty-four hours apart ; after nine days the mare was 
entirely cured. In the Observation III, it was a mare injured two weeks 
previously : a kick had opened the femoro-patellar joint. A blister 
having failed, a trochiscus of sublimate corrosive was introduced into 
the fistula ; eight days later, it was obliterated. Superficial cauteriza- 
tion of the wound (Dubois), tannin (Causse), have also obtained cures. 

Many successes have been related by the use of continued cold water 
irrigation. Let us mention specially those of Sepulchre, Barreau, Eloire. 
The observation of this last author is that of a horse that had fallen in 
going down a stiff hill and had been dragged by the vehicle. The stifle 
presented a wound large enough to admit the fist. " It left exposed on 
the right the internal vastus, which has received the shock almost alone ; 
on the left, the tendon of insertion of the long abductor of the leg, some 

1 Mercier, Rec. de Med. Vet., 1840, p. 461. 



540 VETERINARY SURGICAL THERAPEUTICS. 

centimeters above the point where it is inserted upon the internal patellar 
ligament ; at the bottom and between these muscles, some centimeters- 
deep, the right articular surfaces of the corresponding condyle of the 
femur, as well as the anterior face of the right inter-articular meniscus, 
could be recognized, and then above and in front the patella. 

" From the gaping wound, which widened transversely when the 
leg was flexed, abundant discharge of synovia escaped, spreading over 
the surface of the leg and there coagulating." * Submitted to irrigations 
of cold water, to which was added a weak proportion of sub-acetate of 
lead and phenic acid, the patient recovered rapidly. 

It is to careful disinfection of the trauma that one must resort at first 
in all cases. A few stitches of suture and a drain are sometimes neces- 
sary. Wadded dressing being difficult to apply in that region, the 
Avound should be closed with iodoformed collodion (Michotte), a plaster 
of sublimate or a strong blister. With large wounds, antiseptic injections- 
are indicated. 

V. — Hock /omt 

The extreme severe nature of deep wounds of the hock is due both 
to the anatomical complexity of the hock, and to the frequency and 
extent of its movements. Let us mention the few successes obtained 
by antiphlogistic treatment (Corroy, Auboyer), by cauterization of the 
fistulas (Desmoulieres, Arnal, Feuvrier), witli tannin (Causse), cam- 
phorated paste (Delwart), starched bandage (Guilmot), Rabel water, 
Plasse's caustic (Mares) Rey with a deep wound of the internal face 
of the hock, made by a nail, applied as many as six cauterizations with 
sublimate ; the horse recovered. Blisters, advised by Tisserant and 
Rey, Pjave often been used in connection with the caustics introduced 
into the fistulas. In Saussol's case, the synovial was open, on the inside 
of the leg, with a wound one centimeter wide : the ragged edges were 
smoothed over with scissors, a twisted suture put on, and a coat of 
mustard and vinegar was applied on the whole internal face of the 
region. In twenty days, the animal resumed work. Duvieusart treated 
with cold water a deep wound of the hock, through which the finger 
could readily enter the joint, and which was already accompanied with 
febrile reaction and marked general symptoms. Recovery was complete 
in a month. 

^gyptiacum has been no less advantageous than with the other joints. 
In a serious wound of the hock, which had remained rebel to emollient and. 
P.abel water, Verrier obtained recovery in ten days. In Observation I^ 

1 Eloire, Archives Veterin., 1S78, p. 609. 



TRAUMATIC ARTHRITIS. 54I 

of Salle, it was a mare that, from a kick on the antero-internal face of the 
hock, had the joint opened. Ten days of eegyptiacum treatment brought 
on recovery. Let us also mention the cures obtained by repeated in- 
jections of glycerine in the fistulas. 

But with all these treatments, failures have been numerous. Anti- 
septic means ought to be preferred. Sublimate or nitrate of silver in- 
troduced in the fistula (Barthe, Ribaud) are not as good as injections of 
Van Swieten. 

With extensive wounds, after disinfection, the edges must be brought 
together with few sutures. 

If already inflammation has spread to the synovial, again antiseptic 
irritation must be preferred. When there are bony lesions, as in the 
case of Barreau, where the cuboid was fractured, no treatment ought to be 
undertaken. 

VI. — Fetlock Joint. 

This articulation is one of the most exposed to injuries. With emol- 
lients, Gelle has obtained the cicatrization of a deep wound of the fetlock 
produced with a prick of a fork. In the case of Corroy, emollients and 
tincture of aloes dressings also brought on recovery. .Pretot treated 
with baths and dressings of tincture of aloes an articular wound of the 
fetlock, following too severe firing, and complicated with partial necrosis 
of the first phalanx ; recovery was obtained in twenty-five days. With a 
deep wound of the metacarpo-phalangeal joint, Feuvrier used first emol- 
lients, afterwards lines firing all over the fetlock. In less than a month, 
the horse resumed work. 

In one of the observations of Rey, there was a large wound on the 
anterior face of the fetlock with synovial discharge. The joint was very 
painful and the leg swollen up to the hock. Several blistering applica- 
tions were followed by radical recovery. Sublimate has also given ex- 
cellent results. In the Observation III of Rey, there was a deep wound 
of the right hind fetlock, with purulent synovial discharge ; in eleven 
days he was cured with three successive applications of sublimate. 
Observation IV presented, on the left anterior fetlock, a bruised wound, 
15 centimeters long and 10 wide, complicated with open joint ; three 
applications of sublimate arrested the synovial flow. In the case of 
Knoll, it was a horse which had a wide deep wound of the left fore fet- 
lock, the joint and the great sesamoid sheath were open. After trying 
emollients for fifteen days, sublimate was resorted to, and the wound 
healed in twenty days. Guilmot has advocated starched dressing. 
Observations II, III, IV and VIII of his report, relate to the fetlock 
joint. In the first, a two-year-colt had it opened with the rope of his 



542 VETERINARY SURGICAL THERAPEUTICS. 

halter ; the wound was wide, the articular surfaces could be felt with the 
finger ; tight linen rollers coated with starch were applied from the 
pasterns to the knee ; after a month, the horse worked. In Observation 
VIII it was a cow which had one of her metacarpo-phalangeal joints 
opened with a hook. The treatment was begun the fifteenth day. A 
splinter was first removed, a starched bandage applied ; nineteen days 
after, the wound was all healed. 

Continued irrigation has its part of success (Duvieusart, Arnal, 
Sinoir). In Sinoir's case, the deep wound existed for a week, the 
lameness was very great, and the fever high. In a few days, irrigation 
brought on the closing of the synovial wound. In the report of Verrier, 
recoveries by aegyptiacum are mentioned, which were obtained no less 
rapidly. Observation II was a peculiarly serious case. After enlarging 
of the wound and segyptiacum injections made three times a day, 
recovery' occurred in two weeks. Many other successes were obtained 
■with the same agent. More recently, Aureggio has related cases of 
cures by injections or dressings of glycerine. 

For arthritis of the fetlock, as for others, all those treatments must 
make room for antisepsy. A recent wound should be irrigated with 
tepid Van Swieten solution, then covered with an iodoformed wadded 
dressing. One of us has published the excellent results obtained with 
this method. 

If already the articular infection exists, free incision of the wound 
should be followed by frequent injections in the joint. Mauri and his 
pupil Negre have recommended sublimate. 

In the case of Mauri, a blister was applied upon the whole joint and 
frequent injections of Van Swieten made in the fistula. The third day, 
the discharge was already reduced ; the seventh, it had stopped en- 
tirely ; the animal walked in its box, resting on the whole plantar sur- 
face. With the patient treated by Negre, the same treatment was used 
(blister and Van Swieten injections every two hours) ; recovery took 
place rapidly. 

VII. — Phalangeal Joint. 

Although deep wounds of the Jirst phalangeal ]omt are quite common, 
only rare observations are related. In that of Mercier, published in 
1826, the joint was open transversely for about one centimeter and a 
half ; there was no standing on the leg. Dressings of compound 
tincture of camphor brought on recovery in fifteen days. A horse 
treated by Verrier had a wound of the anterior face of the pastern ; a 
flap of skin had been torn, the joint was open. " Bleeding, baths^ 
poultices, then aegyptiacum, closed the wound in fourteen days." The 



TRAUMATIC ARTHRITIS. 54$:; 

lameness lasted a long time, " on account of the hard swelling which 
surrounded the diseased region." 

With recent wounds, disinfection and an antiseptic dressing constitute 
the choicest treatment. When there is arthritis, it is often complicated 
with tendinous, ligamentous or cartilaginous necrosis. After enlarging 
the wound, continued irrigation or antiseptics should be used. 

Ankylosis is a termination, less unfavorable than to other joints, on 
account of the limited motions which the arthrodia performs ; but it is 
often accompanied with voluminous periostitis, which, later on, imposes 
neurotomy. 

The articulation of the foot, though protected by the superior bor- 
der of the wall, is one of those where traumatic lesions are most 
frequently observed. In days gone by, when cartilaginous quittor was 
operated by the entire extirpation of the fibro cartilage, it frequently 
happened that the lateral cul-de-sac of the articular synovial was open. 
Already in 1828, Pauleau spoke of the relative benignity of those 
wounds of the joint of the foot. Vatel has several times opened it on 
purpose, without observing the slightest accident ; the animals recov- 
ered quickly and as well as those in which the synovial was respected. 
However, the rule is not without exception. With well-made antisepsy, 
the opening of the articular synovial during the operation for quittor is 
still less dangerous than before. A thorough washing of the wound 
with the solution of Van Swieten and an iodoformed dressing prevent 
all complication. Considerably more serious is the prognosis, when the 
joint has been perforated with a dirty infected instrument or when its 
opening is due to the mortification of peri-articular tissues (cracks, 
quittor, complicated nails in the foot). Then, almost always, the joint is 
invaded by suppurative inflammation, ordinarily ending by ankylosis. 

Our publications contain, however, examples of rapid recovery of 
those lesions, which seemed to imply a fatal termination. Pauleau 
(1829), in one case of articular fistula, situated in front of the coronet, 
used first "antiphlogistic means, then thinned out the hoof covering the 
diseased tissues, and made a camphorated dressing with pads dampened 
with tincture of aloes. Six days later the synovial discharge had 
stopped ; shortly after, recovery was complete. Mercier has related two 
recoveries of pedal arthritis with Rabel water. In the first, the articu- 
lation was the seat of high inflammation, the febrile reaction was great, 
purulent synovial discharge took place from the fistula ; a first dressing 
gave no result, the eleventh day Rabel water began to be used ; in ten 
days healing was completed ; the joint kept the freedom of all its 
motions. In the second case the horse had a nail in the foot, which, , 
according to the author, involved positively (?) the phalangeal joint : 



544 VETERINARY SURGICAL THERAPEUTICS. 

between the third phalanx and the small sesamoid. Delafond obtained, 
in two months the cure of an arthritis due to a nail in the foot. In the 
case related by Courdouan, the lesions were of extreme severity. 
■' The weight of the hoof alone made the joint open two centimeters at 
least, and if we try to flex it laterally, it dilates so much that a stroke of 
bistouri at each commissure of the wound would separate entirely the 
hoof from the third phalanx ; the little sesamoid is separated almost 
completely ; it holds only by one of its extremities." Emollient baths 
and alcohol dressings brought on ankylosis in a month without great de- 
formity. Delorme tells, without detail, that with a blister he obtained in 
twelve days the recovery of a very severe wound of the articulation of 
the two last phalanges. In Observation III. of Verrier, it was the case 
of a pedal arthritis which had occurred after the operation for nail in the 
foot. After vainly trying emollients, tincture of aloes, blisterings, injec- 
tions in the fistulas, the author used aegyptiacum, introduced some of it 
as deep as possible with a probe ; all the fistulas healed in fifteen days. In 
the case of Foelen, the articular borders of the second and third pha- 
langes could be felt with the finger, through a wound of the internal side 
of the foot. Every day a pad of oakum covered with aegyptiacum was 
applied on the wound ; in three weeks recovery was complete. Saude, 
after the operation for nail in the foot, with lesions of the navicular bone, 
had to treat an arthritis. The inferior wound was dressed with 
glycerine, alcohol was injected in the fistulas of the coronet ; six weeks 
later, all lameness had disappeared, even in trotting. In a case of nail 
in the foot with fracture of the navicular bone, where Humbert re- 
moved the bone, three weeks after, recovery was certain. Sesamoidectomy 
has been unsuccessful with Moller and all those who have tried it. 

Since the communication made before the Societe Centrale de 
Medecine Ve'te'rinaire in 1853 by Bouley, continued irrigation has been 
the classical treatment of pedal arthritis, following necrosis of the anterior 
lateral ligament or an opening of the lateral cul-de-sac of the synovial. 
In the paper of Trasbot (1877), there is a remarkable example of re- 
covery: a horse, affected with quittor, complicated with necrosis of the 
anterior lateral ligament and opening of the synovial, was submitted to 
irrigations three days after the operation ; the wound cicatrized in 
ten days. Like many other veterinarians, we have obtained similar 
results. To insure the irrigation of the wound, it is often necessary 
to apply a drain. The superiority of continued irrigation upon the 
other means recommended before antisepsy is demonstrated by many 
iacts. 

But for quiet animals, easy to dress, we prefer the disinfecting solu- 
tions in baths, injections and with dressings. As we write this article. 



CLOSED IDIOPATHIC ARTHRITIS. 545 

^e have in our care a magnificent animal cured from a pedal arthritis 
with baths and antiseptic dressings. Hydrotherapy, carried on for 
twelve days, had failed to produce any improvement. 

In the quite numerous cases where lameness remains, high neurotomy, 
that of the median or of the sciatic, must be resorted to. 



VI. 
CLOSED IDIOPATHIC ARTHRITIS. 

Between closed and traumatic arthritis there is the difference which 
exists between contusion and contused wound : no foreign body coming 
from the outside has entered the joint ; that explains the rarity of sup- 
puration in closed articular inflammations. We do not speak here of 
the infectious arthritis ; they will be considered farther on. Those that 
we will examine now result from local causes which, without opening 
the synovial, promote inflammation in them. 

Wounds of joints which are not penetrating, violent contusions, 
sprains, luxations, epiphysar fractures, are the usual causes. 

Closed arthritis is announced by heat, soreness and swelling. The 
synovial secretes freely ; in its inside the fluid accumulates and 
dilates the weak points, but the peripheric oedematous swelling frequently 
conceals the dilatations. The characters of the intrasynovial effusion 
have permitted their division into serous, pseudo-membra?ious or purulent- 

To reduce the inflammatory manifestations is the first indication of 
treatment. General and local bleeding are useless. Even for the artic- 
ulation of the foot, the traditional local bleeding at the toe is abandoned ; 
it exposes to suppurative infection of the sub-horny structures. Em- 
ollient ointments, poultices, white lotion compresses, camphorated 
alcohol, are not as good as cold (baths, douches, continued irriga- 
tion) or immobilization with an appropriate bandage. " Immobility 
\s, par excellence, the antiphlogistic treatment of an inflamed joint "; it 
insures rest for the tissues and allows the rapid repair of articular le- 
sions. Speaking of sprain of the fetlock, we have shown the beneficial 
effects of the bandage of Delorme. By the immobility and compression 
it produces, this bandage constitutes a good treatment for more exposed 
articular phlogosis. Its application is simple upon the phalangeal 
joints, that of the fetlock, knee and hock. With the superior articula- 
tion of the extremities (shoulder, elbow, hip, stifle) pitched plasters are to 
be recommended. There is often advantage to combine immobilization 
with refrigeration. Many practitioners, from the start, use blistering 
preparations, so as to modify the synovial inflammation; they are ad-- 



54^ VETERINARY SURGICAL THERAPEUTICS. 

vantageous only when the inflammatory phenomena are moderate or 
have already subsided. 

If the synovial dropsy is very abundant, puncture of the joint 
must be made. On the most prominent point of the tumefaction, the 
skin is shaved, soaped and washed with alcohol or Van Swieten. The 
trocar and hands of the operator should be carefully disinfected. The 
extracted fluid is sometimes clear, at others a little fibrinous, now red- 
dish or already cloudy and on the road to suppuration. In this last case, 
the washing of the serous may prevent suppurative arthritis. With an 
aseptic syringe, or, better, with Dieulafoy or Potain aspirator, an injection 
is made in the synovial, with a solution of sublimate i p. looo or phenic 
acid 3-5 p. 100 ; this is afterwards drawn out; it is renewed until the 
fluid that comes out is limpid, and free from the clots that soiled the first 
injections. The washing finished, the wound is closed with collodion and 
the region covered with a wadded dressing. Thus the joint is purified 
as much as possible. But the result is not always favorable ; when al- 
ready pyogenous microbes brought by the circulation to the joint, have 
begun their depredations, often the joint becomes purulent, and the pus 
makes its way outside, necrosing the peri-articular tissues. The treat- 
ment then must be that of traumatic arthritis. 

Closed arthritis, not complicated, leaves often after itself a joint stiff, 
sore, impotent, with a certain degree of hydarthrosis. Hot effusions, 
massage, compression, blistering and firing are the means to be resorted 
to. After a sufficient rest, work can be resumed gradually. At times 
the chronic form is complicated with periostosis and false ankylosis. 
(See Art/i?-itis Deformans and Ankylosis^ When these lesions exist in 
the lower joints of extremities (knee, fetlock, phalangeal articulations) 
radial or tibial neurotomies are indicated. Several horses suffering with, 
chronic arthritis of the knee were neurotomized by MoUer and did work 
in trotting afterwards. 

VII. 

INFECTIOUS ARTHRITIS. 

In animals, besides traumatic and essential closed arthritis, numerous 
other articular inflammations exist, whose pathogeny, for some at least, 
is yet unknown. They are not due, like the former, to external violence, 
sprains, action of mechanical, physical or chemical agents ; all seem to 
constitute manifestations or epiphenomena of general or infectious 
diseases. 

We will only name x!c^% glanderous arthritis , so frequently observed in. 



INFECTIOUS ARTHRITIS. 54/ 

former times. Produced by the specific bacillus, its severity depends 
altogether upon the affection to which it belongs. Pneumonia, Peri- 
pneumonia, variola, are sometimes accompanied with arthritis, which 
may assume rheumatismal character and end in suppuration. Purulent 
infection frequently gives rise to multiple arthritis with rapid development. 
The bacteriological study of the pus of the diseased joints reveals the 
presence of the staphylococci or the streptococci. Distemper m^y be ac- 
companied with arthropathies. Megnin has seen one case in which 
recovery was raidly obtained by blisterings and administration of arsenic 
internally. However, rheumatismal arthritis is rare ; the streptococcus 
of Schiitz is essentially pyogenous ; suppuration is the ordinary ter- 
mination of its articular localizations. 

■ Tuberculous arthritis has been observed in cattle, pigs, cats and birds. 
If articular tuberculosis can be primitive, exist in the absence of any 
visceral lesion, most ordinarily it is sccojidary and represents a single 
accident of the bacillosis. The experiments of Max Schliller, repeated 
several times, have shown that it is easy to produce it in bruising a 
joint in infected subjects. Most of tuberculous arthritis of animals are 
without doubt occasioned by accidental traumas ; the contusion trans- 
forms the injured region into a spot of less resistance, opening at the 
same time the blood-vessels, which pour out their bacilli. The altera^ 
tions may begin in the synovial, but most ordinarily the epiphysis are 
affected first ; a center of caries is developed and also fungositus which in- 
oculate the S3-novial ; later, lesions are found in all the tissues of the joint. 
According to their characters, tuberculous arthritis have been divided into 
various forms — arthritis with hydarthrosis, with riziform granulations, 
cold abscess, fungoid arthritis — forms which have been as yet but little 
studied in our animals. According to the virulence of the bacillus and 
the resistance of the tissue, the lesions are acute, sub-acute or chronic. 
Articular tuberculosis is not very rare in bovines (Guillebeau and Hess, 
Moller, Noack, Lucet). Under the name of rheumatismal arthritis 
(Goux), goutte (Pradal), /ungoid artJvitis (Requier), have been described 
in swine arthropathies, whose nature has not yet been determined^ 
If some among them seem to be related to rachitism or rheumatism there 
are others which seem of tuberculous nature (Violet). Bergstrand has 
related a case of bacillar arthritis of the metatarso-phalangeal joints in a 
pig. Tuberculous arthritis is very rare in dogs. Nocard has seen it 
once in a cat. In domestic gallinaceans and birds that are kept in cap- 
tivity, they are relatively frequent. Larcher has given a very good 
description of their clinical manifestations. When they are in the way 
of development, the inferior extremities are taken with spasmodic move- 
ments ; the birds have difficulty to stand on their legs, the walk is 



548 VETERINARY SURGICAL THERAPEUTICS. 

Staggering, lame ; many stand immobile, as if paralyzed. If one of the 
superior legs is affected, the animal has difficulty to fly or perhaps is 
unable to. The joints are the seat of partial tumefactions, first soft, 
later indurated and without tendency to diminish. Sometimes the 
various layers which compose them dry off and successively exfoliate; at 
others they ulcerate ; the wounds resulting from this ulceration are fis- 
tulous, with fungoid edges, bleeding, and present at their bottom a 
yellowish scaly or granular matter. Articular surfaces are extensively 
altered, sometimes the bones necrosed. Bacilli are found in various 
numbers in the affected tissues and in the peri-articular carious deposits, 
where in general they are less frequent. We have gathered several 
cases of tuberculous arthritis of hens, with lesions very rich in bacilli. 
The researches of Eberlein have shown that, on phthisical parrots, tuber- 
culous arthritis is counted in the proportion of 25 p. 100. 

The treatment of articular tuberculosis of animals is of secondary 
interest. (See Tuberculosis.^ 

I. — Articular Rheumatism. 

Acute articular rkeuftiatism, specially common in cattle, observed also 
in horse, dog and pig, is a special disease, differing from the pseudo- 
rheumatism which sometimes occurs with pneumonia, distemper, pleuro- 
pneumonia, puerperal infection. To support its specific nature, are in- 
voked : I, the febrile symptoms and the characteristic initial period 
of infectious diseases ; 2, the simultaneous attack of joints more or 
less apart from each other; 3, the endocarditis which sometimes comes 
and complicates rheumatism ; 4, its apparition in model stables or where 
cold could not be incriminated (Friedberger and Frohner). Cold enters 
in the genesis of this affection only as an occasional cause. 

If bacteriological researches have not yet entirely elucidated the 
pathogeny of rheumatism of man, they have shown that the diseased 
synovials contain ordinarily micro-organisms, most commonly sta- 
phylococci (Bouchard and Charron). Schiiller has found in them a 
short bacillus, which, inoculated to animals, gives rise to articular 
lesions. 

The beginning, often insidious, may make one suspect the presence of 
an internal disease. But the lameness, the local pain and hyperthermia, 
the multiplicity of the joints affected, the ambulatory character of the 
inflammation, are sufficient to establish the diagnosis. The observatioa 
reported by Trasbot in the Archives of 1877 is truly typical. During 
the development of these arthritis, there often occur other rheumatisma^ 
manifestations upon the visceral serous, specially upon the endocardium. 

As soon as rheumatism is diagnosed, a proper hygiene shall be 



INFECTIOUS ARTHRITIS. 549 

prescribed. The patient shall be kept in a warm stable, protected from 
-drafts of air and dampness. In winter, he will be covered with blankets 
and his legs bandaged. For food, he will receive warm mashes. 
Bleeding, advocated for a long time, has a doubtful efficacy. Tartar 
-emetic and other agents have also for a long time enjoyed a reputation 
little deserved. To-day all authors agree 'in recognizing the superiority 
of salicylate preparations. Successively the alkalines, salicyline, 
salicylic acid, have been used, then salicylate of soda, which has shown 
itself more efficacious than the others. To large animals it is given in 
doses from 60 to 100 grammes ; to dogs, a few grammes only. This 
agent quietens the pains and lowers the temperature. Lately, antypyrine, 
exalgine, phenacetine, sulphate of quinine, salol, naphtol, have been 
recommended ; their action is inferior to that of the treatment by sali- 
cylates. If this should be contra-indicated (renal lesions, albuminuria), 
sulphate of quinine and bicarbonate of soda shall be used. Local 
applications (phenicated or camphorated ointment, that of populeum 
acid, laudanum, poultices) have but little effect. Suppuration, which 
is exceptional, is due to a secondary infection. 

Chronic articular r/ieumafis?n may appear at once under that form or 
follow the acute state. Swelling and pain vary in their severity. 
Localized to the legs, the affection gives rise to a continued or inter- 
mittent lameness. After a certain time, the articular borders tumefy, 
crackings are heard in the joint, osteophytes develop on the edges 
of the articulation. The lesions keep growing, and become dry de- 
formans arthritis. The treatment of this chronic form differs little from 
that of the acute, but is little beneficial. It is again by well under- 
stood hygiene, avoiding cold and dampness, the use of salicylates, bicar-' 
bonate of soda, arsenic, that improvement of the general condition can be 
looked for. Locally, tincture of iodine, blisters, cauterization have seemed 
advantageous. If there is large synovial dropsy, puncture is resorted 
to. On a steer, Persillet has used with success puncture and compres- 
sion with wool bandages. 

// — Arthritis of Milch Cows — Post-Partujti Arthritis. 

This arthritis, also c^Wtd pseudo-rheiwiatismal, is almost always local- 
ized to the stifle, sometimes to the knee or the hock. It is character- 
ized by a severe lameness, swelling of the joint, and synovial dilata- 
tions. Studied by Coulbeaux, Pauleau, Heu, Rossignol, Auer, Fur- 
lanetto, its etiology has remained obscure for a long time. Pauleau, 
who has treated more" than eight hundred cases, has remarked that 
•*' most ordinarily it precedes or follows abortion, or that it manifests 



550 



VETERINARY SURGICAL THERAPEUTICS. 



itself after a laborious calving or an incomplete delivery." The same: 
author accuses also barns badly kept, where cows lay always in the: 
dirt. To-day, it is admitted that this arthritis may follow parturition,, 
abortion, or appear as accidents of metritis, of some inflammatory- 
affections of the genital organs, aphthous fever, enteritis, mammitis- 
(Rossignol). It is not yet known if it is determined by an intrasynovial 
microbian puUulation, or by toxines elaborated in the genital organs. 
In a case of femoro-tibial arthritis that we have observed, the sowing 
of the synovia has given cultures of a micrococcus having all the char- 
acters of the staphylococcus albus. 

Ordinarily, the march of the disease is chronic or sub-acute. In ex- 




Fig. 113. — Femoro tibio-patellar arthritis. (From a photograph.) 



ploring the stifle, one observes a puffy swelling of the region, but the 
synovial tumors, especially the internal, indicate plainly the articular 
dropsy. At a more advanced period, the walls of the distended synovial 
may become calcareous. The process does not end in suppuration. 
"Never," says Pauleau, "have I seen, at any period of the disease, pus 
formed in the diseased parts." 

The prognosis is serious. The affection is very tenacious ; left to 
itself, it rapidly brings on loss of flesh ; death sometimes occurs in 
marasmus. 

A.ntisepsy of the genital organs after parturition or abortion is at 
present the only prophylactic indications. 

Pauleau and many other practitioners have noted the little eflficacy 
of irritating topics and of the numerous liniments recommended.. 
Cauterization succeeds often. The cow represented in fig. 113 entered 



INFECTIOUS ARTHRITIS. 55 I 

our clinic in August, for a femoro-tibial arthritis ; we treated it with needle 
firing. After six weeks, recovery was complete. Blistering frictions 
with nitrate of mercury have been recommended (Heu), or those of 
bichromate of potassa (Guittard). Furlanetto prefers this in the pro- 
portion of 4 parts of bichromate to 30 of lard. Pauleau has obtained 
numerous successes with cauterization by sulphuric acid. Out of 806 
cases treated, he only had 57 failures. He proceeds as follows : 

" He takes half a decilitre of sulphuric acid sold in commerce and a 
brush made with a wooden stick, as big as the finger, having a little 
pad of old linen at one end. The hair is cut over the pre-eminent 
tumors. The head of the animal is held firmly by an assistant ; another, 
placed on the side opposite that to be operated on, takes hold of the 
tail with one hand and of the teats with the other ; he pulls towards 
him the mammae to isolate it from the sick leg, and permits the ap- 
plication of the drug on the inside tumor. The mammae is covered 
with a coat of greasy substance to protect it from the contact of the acid. 

" With the brush dipped in sulphuric acid, the surface of the tumor is 
frictioned. A simple embrocation would not be sufficient, a friction of 
one minute is necessar)\ Care is taken so that the fluid does not 
spread beyond the diseased parts, nor drop between the toes. If the 
animal is affected on both sides together, it is better to operate on the 
second leg only four or five days after the first. The operation done, the 
animal is returned to her barn and tied short to prevent her biting her- 
self. After fifteen minutes she is left loose. If the cow show articular 
lancinating pains, it is proper to make, on the diseased part, several 
frictions with camphorated alcohol, and only after four or five days, 
Avhen the animal begins to rest on his leg, to apply the radical treat- 
ment. 

" Two days after the friction, the external enlargement is entirely 
flattened, the internal has diminished in size only. The skin, covered 
with scabs, has the appearance of being tanned. There is scarcely any 
swelling round the eschar. However, in fine skin individuals, the 
tumefaction may become very large and run down along the leg. I 
prescribe only frictions of camphorated alcohol with the addition of a 
little ammonia (i part in 20). 

" Fifteen days, three weeks, perhaps a month or more will pass before 
the scabs become loose. Even when the skin is destroyed in its whole 
thickness, there must be no fear about the sloughs of skin which take 
place especially at the internal face of the joint, where during walking 
there are constant rubbings ; those sloughs recover perfectly. 

" In summer, the wounds are dressed with empyrheumatic oil to keep 
ilies away ; in winter tincture of aloes or spirits of turpentine is used. 



552 VETERINARY SURGICAL THERAPEUTICS. 

The definite result of the treatment is most ordinarily a radical cure of 
the patients." ' 

Rossignol has obtained good results with one simple slight applicatioa 
of trade sulphuric acid. 

According to various authors, the sudden arrest of the lochia, occur- 
ing in a cow well delivered, will occasion sometimes an arthro-synovitis 
of the hocks. This affection, already mentioned by Lecouturier, Deneu- 
bourg and others, would disappear in a few days. Furlanetto advises 
the salicylate of soda internally and frictions of warm oil on the hocks. 
The application on the loins of a sachet containing hot ashes will stim- 
ulate the return of the lochia. 

///. — Arthritis of Netv-Borns. 

Arthritis of young animals is an affection which occasions consider- 
able losses. Observed in all species, it affects particularly colts, calves,, 
lambs and young pigs. Up to about the middle of this century, it 
killed about one-fifth of the suckling subjects (Lecoq). In the na- 
tional haras of Wurtemberg, out of 187 colts that died during a period 
of fifteen years, 85 were killed by this disease (Hering). Its frequency 
has diminished with the progress of the hygiene of stables and barns, 
but its mortality has not diminished in a sensible proportion ; it reaches 
yet 70 to 80 per 100 of the subjects affected. And most of those that 
survive remain witla chronic swellings of the joints or synovial dropsies^ 
with despairing tenacity ; hence the axiom of Norman breeders, " Lame 
colt, lost colt " (Lecoq). 

In the majority of cases, pyohemic arthritis occurs in the few days 
following birth. Out of 67 colts treated by Hering, 47 (70 per 100) 
died in the three first weeks of life. 

No joint is exempt from it, but the hock, knee, stifle, elbow, hip and 
shoulder, are those most commonly affected ; it is, however, quite fre- 
quent on the fetlock, the coronet and the costal and intervertebral joints. 

The invasion is sudden. Ordinarily preceded by general symptoms, 
the articular tumefaction, warm, tense, painful, increases rapidly. Al- 
most always several articulations are affected simultaneously. Death 
may take place after twent3'-four or forty-eight hours, but in general the 
march of the disease is not so rapid ; sometimes the inflamed regions 
open and give escape to purulent synovia. 

Few diseases have had an etiology and therapeutics so changeable ; 
few have given rise to so many erroneous conceptions. There have been 
successively accused : the change of regime imposed on the mother 

1 Patileau : Rec. de Med. Vet., 1869, p. 435. 



INFECTIOUS ARTHRITIS. 553 

towards the end of gestation (Lecoq), the bad quality of the milk and 
the privation of the colostrum (Darreau), heredity, exposures to cold 
(Delafond), insufficient feeding (Roloff) . . . and even as far as the 
persistency of the foramen of Botal ! Bollinger was the first to consider 
the disease as an infection having its origin in the inflamed suppurative 
umbilical cord. The infection of the wound of the umbilicus, through the 
putrid decomposition of products covering the soil of stables or barns, was 
the starting-point of the morbid process. Bollinger mentioned as predis- 
posing conditions : the puUings of the umbilical blood-vessels at the 
time the cord is torn, its rupture on a point too near the abdomen, the 
contusions of the umbilical wound, traumatisms of the abdominal walls? 
and, lastly, birth during a cold season. The long sojourn of animals in 
stable, increases in it the proportion of putrid matters, and thus pro- 
motes the infection of the umbilical wound. 

Morot reconsidered this etiology in 1884. For him, the cause of all 
the trouble is the persistence of the urachus ; it is the pouring of the 
urine, which ferments, becomes irritating, and afterwards brings on the 
inflammation of this canal and omphalo-phlebitis. He advises to treat 
the urinary fistulas by cauterization or ligature. By leaving a certain 
length to the cord, and protecting it from injurious contact by a linen 
bandage, these fistulas are prevented. Chassaing claims that exudative 
and purulent arthritis are two distinct diseases. The first is due to a 
sickly condition of the mother and the bad quality of the milk, while the 
second is caused by the inflammation of the urachus or of the umbilical 
vein, as taught by Bollinger. Cagny insists in believing that umbilical 
phlebitis and arthritis of young animals are two distinct affections ; he 
finds them very different in their march, and it is only exceptionally 
that they have been observed on the same animal ; for him, umbilical 
phlebitis is followed by death in the eight days following birth, before 
the appearance of the articular symptoms, while the arthritis has a 
slower march, attacks successively various articulations, and in general 
kills only after complete cicatrization of the umbilical vein. But these 
numerous forms of the disease, these differences observed in its malig- 
nancy and march, seem to be the result of the diversity of micro-organisms 
able to promote it, or of the degrees of virulence of its producing agent, 
in admitting that this should be unique. It is considered as demon- 
strated to-day that pyohemic polyarthritis of colts, calves, lambs and 
young pigs is, as announced by Bollinger, a general infectious dis- 
ease, beginning by a phlegmasia of the umbilical cord and produced 
by the agents of this inflammation, principally by the streptococcus vul- 
garis (Nocard, de St. Germain). 

The treatment has considerably varied, according to the admitted 



554 VETERINARY SURGICAL THERAPEUTICS. 

pathogenic doctrine. Lecoq advised bleeding, repeated emollient 
lotions, cold baths, lotions with sulphate of iron ; the mother was sub- 
mitted to a severe diet, and the young one deprived of part of its 
ration. Darreau praised purgatives (sulphate of soda, aloes), with 
applications of populeum on the joints. The infectious theory of the 
disease calls particularly the attention to its prophylaxy : avoid the 
infection of the umbilical cord, purify it with strong antiseptic solution 
if it is soiled ; keep the place where the animal is as clean as possible ; 
such is the indication. Bollinger recommends to ligate the cord, assist 
the cicatrization of the umbilical wound with antiseptics and apply on 
the abdomen a protective bandage or more simply a coat of tar. The 
stable should be well aired ; the faeces and dirty bedding removed often. 

The curative treatment includes the disinfection of the umbilical 
region (phenic or cresyled water) and the application on the wound of 
antiseptic vaseline. Some practitioners continue to give purgatives 
(sulphate of soda and cream of tartar); others antiseptics (calomel, salol, 
napthol). Salicylate of soda (2 to 8 grammes) has little efifect. Stimu- 
lants (alcohol, wine, cofTee) are indicated to sustain the patient. Against 
the articular tumefactions, therapeutics can do but little. To the popu- 
leum will be preferred vaseline, with or without antiseptic or narcotic sub- 
stances. If suppuration occurs free exit must be allowed, by opening 
the collection, and then treat with antiseptics. Muscular abscesses 
demand the same means. But when such serious lesions exist it is more 
economical to sacrifice the subject. 

Against chronic articular swellings blisterings and cauterization will 
be resorted to. As remarked by Darreau, those synovial tumors aie 
ordinarily very difficult to remove. 

VIII. 

HYDARTHROSIS. 

Dropsies of articular synovials have numerous causes — contusions, 
luxations, sprains, peri-articular wounds, inflammations of joints. Often 
during these affections the articular synovial " swells more or less pain- 
fully " on its weak points through an effusion which takes place in its 
cavity. Sometimes these phenomena gradually diminish and leave 
nothing after them ; at others, the acute symptoms diminish and the 
hydarthrosis remains. In animals used as motors, they are ordinarily 
seen developing without noticeable inflammatory manifestations. Soft, 
fluctuating tumors, painless, appear in some parts of the joint ; they 
increase little by little, and at last give rise to lameness. Few horses, 
used for a long time to hard work, are free from them. Let us remark 



HYDARTHROSIS. 555 

again that the joints in which motions are most active are also those 
that are more affected. It is, indeed, in the fetlock, hock, knee and 
stifle that they are most ordinarily observed. Lymphatism and heredity 
have been incriminated as cause. Certainly there are animals in which 
hydarthrosis occurs without being promoted by efforts, or hyperf unction 
of joints, but, without contestation, exaggerated work is the great occa- 
sional cause. Let us add that some dropsies have special causes. They 
have been seen to appear during gestation, and disappear generally with 
parturition, and without being serious. There are some which develop 
after delivery, and are more serious than the preceding ones. Again, 
various morbid conditions, general or infectious, particularly rheuma- 
tism and distemper, may be accompanied by them. 

At the onset of some hydarthroses are sometimes seen a little heat, 
pain on palpation and a .slight lameness ; but in general the disease 
develops slowly, without producing lameness at the beginning. Little 
by little the synovial tumors enlarge, harden ; the " fluid, secreted in 
abundance, may become the cause of a lameness resulting specially from 
the obstacle its accumulation opposes to the free function of the joint. 
At rest, the animal assumes a special position corresponding to the 
capacity maxima of the serum. In old dropsies, with abundant effu- 
sion, there is sometimes separation of the bony surfaces and a true lux- 
ation takes place. At the autopsy of a horse suffering from an old lame- 
ness of the hip, Vitet found " such relaxation in the coxo-femoral joint, 
that the head of the femur would at times leave the cotyloid cavity and 
return into it without difficulty." 

With the exception of some rare cases, the diagnosis is easy. At 
each joint the synovial makes hernia in special places, always the same ; 
which permits the differentiation between hydarthrosis and hygromas and 
■dropsies of tendinous sheaths. Sometimes the clinical physiognomy is 
modified by the presence of one or more septums in the dropsical serous. 
The distentions of one cul-de-sac may be wanting or only slightly 
accused. 

The prophylaxy of hydarthrosis must be guided by the consideration 
of the causes promoting them. Acute affections of joints (wounds, con- 
tusions, sprains, luxations, arthritis) shall be treated according to the 
indications we have presented ; the active function of the articulation 
shall be avoided before the complete disappearance of the inflammatory 
symptoms. The mfluence of exaggerated work, not in proportion with 
the age, the resistance of the tissues, demands the methodical training 
of young animals. A more judicious selection of the breeders is recom- 
mended. " Males which are subject to hydarthrosis ought not properly 
to be used for reproduction. Females affected with them must be served 



5.56 VETERINARY SURGICAL THERAPEUTICS. 

"by stallions with dense tissues. They ought to be used to breed mules. 
Subjects born of parents affected with hydarthrosis ought to emigrate 
towards dry localities. P'or them aqueous food is contra-indicated. 
Feeding with oats, beans and the like is often sufficient to bring on the 
disappearance of these affections. But it demands six months and some- 
times years to reach this modification." ' 

The treatment varies according to the age and the degree of the 
dropsy, the modifications of the synovial and of the tissues surrounding 
it. Against recent hydarthrosis, a number of means are recommended. 
Rest of the joint is always beneficial ; it stops the effusion and favors 
the absorption of the synovia. Complete immobilization is impossible in 
animals, and it is not necessary ; the subject is turned loose in a box or 
in the field. Compressions, much used in stables of the rich, helps rest 
with advantage. The joint is wrapped with linen or flannel roller from 
"below upwards with quite strong compression ; this is increased by 
wetting the roller before its application. To-day, especially for race- 
horses, rubber stockings of various shapes are used. Some, passed 
over the hoof, come to envelop exactly the diseased joint ; others are 
laced with strings ; all have the advantage of resisting in a permanent 
manner the dilatation of the synovial. 

To compression astringents are frequently added : white lotions, styptic 
solution, alcohol, tincture of camphor, poultices of clay, paste of com« 
mon chalk diluted in vinegar. Cold water is yet, with immobilization, 
massage and compression, the treatment par excellence of recent hydar- 
throsis. Douches and baths in running water may be utilized. After 
each seating of hydrotherapy the joint may be massed and enveloped 
■Avith a roller or a rubber stocking. Against hydarthrosis, aloes, sulphate 
of soda, squill, colchicum, nitre, and all the series of diuretics have been 
administered internally. These remedies have no action upon the 
affected synovial serous. 

When hydarthrosis have reached a certain size, these treatments are 
no longer sufficient. More active measures are necessary. Blistering 
applications are then indicated : tincture of cantharides, blister ointment, 
English and French strong liniments, those of Geneau, Boyer, the topic 
of James, the ointment of Lebas, that of Me're, those of biodide of 
mercury or bichromate of potassa, and a mass of other preparations with 
known or concealed composition, all have been recommended. 

Even tincture of iodine, in frictions, has had its advocates. Delree 
has praised it : " The treatment that I use has given me complete re- 
coveries, without relapse, loss of hair, even in well-bred horses, with- 

1 Iv. Eafosse, Pathol, vet. t. II, p. 616. 



HYDARTHROSIS. 557 

out leaving a blemish and without preventing the animals from doing 
their regular work. 

" The therapeutic agent that I use is iodine in the following for, 
mula : 

Tincture of iodine 100 grammes 

Iodide of potassa 5 do 

Distilled water 40 do 

" The skin being well covered with this solution, and the hand pro- 
tected, a friction of ten to fifteen minutes is made, and renewed twice a 
day. After each friction, the skin is coated with a greasy substance 
(lard or populeum), 

" After a few days, the skin becomes parchment-like, the tumor 
softens, diminishes little by little, and ordinarily disappears after four or 
six weeks of treatment. I must, however, remark that it is hard to obtain 
the complete disappearance when there are clots of synovia deposited 
in the cavities." ^ 

In our hands, tincture of iodine has not proved itself superior to the 
other counter-irritants, but the contrary. Delree has been obliged anyhow 
to rub it twice a day for four to six weeks. Blisterings have given more 
rapid and at least as satisfactory results. In our clinic we use almost 
exclusively simple blister ointment, the mercurial or the bi-iodide of 
mercury : their action is strong and without severe itching. 

Blisters and tincture of iodine can be used alternately. " Often," 
says Lafosse, " after the use of a blister, I make the scabs drop by rub- 
bing them with oil of iodine or an alterative ointment, then I prescribe 
one friction of tincture of iodine for four or five mornings in succession, 
to be done over again if the recovery is not complete." The same 
author has obtained good results with plasters made of pitch, turpen- 
tine and wax, applied warm over the synovial tumors. This treatment 
produces derivation and immobilization ; it also makes a regular and 
lasting compression over the synovial tumor, which is very beneficial. 
The nature of the blistering agent has not the importance tliat lias been 
attributed to it. A simple coating of the hair with a brush, by a blister, 
gives little or no effect ; a stiff friction, properly made, will produce bene- 
ficial results. From the sixth to the eighth day, hot-water lotions are 
made to soften and wash off the scabs ; douches, massage, compres- 
sion do the rest. 

With large, old, indurated hydarthrosis, cauterization must be resorted 
to. Instead of superficial points firing, we prefer that in lines, in fine 
points or in needles. The accidents of arthritis spoken of are due, not 

1 Delree, Annal de Med. Vet., 1864, p, 456. 



558 VETERINARY SURGICAL THERAPEUTICS. 

to the method, but the lack of abihty or of experience of those who use 
it ; providing the points used are sufficiently fine, no accident is to be 
feared, no more for articular synovial than others. With Paquelin and 
Bourguet needle or the zoocautery, we pierce the synovial in its most 
superficial parts ; the synovia escapes, the serum remains aseptic ; the 
therapeutic effects are in general superior to those of superficial 
cauterization ; the escape of a certain quantity of fluid is allowed, which, 
with the other means, will be resorbed ; the heat carried in the synovial 
produces beneficial changes and on the level of the punctures little 
fibrous spots are formed whose retraction forms round the joint a true 
contentive bandage of great power. Cauterization is the most used and 
most practical treatment. It is certainly, as said Lafosse, " the truly 
heroic treatment." 

Efficacious as it is, firing is not infallible, — and it blemishes. On 
that account, and specially for fine horses, other therapeutic means have 
been looked for, to take its place. It is centuries since it has been 
thought to give escape to that synovia, often thick, grumulous and 
with difficulty resorbable. From time immemorial, Arabs opened the 
thoroughpins of their horses with the red iron. Bruche (1826) punc- 
tured hydarthrosis with the iron carried to white heat, and when they 
were voluminous, he enveloped them with points of firing. From time 
to time we yet meet with arthritis of the hock or the stifle, consecutive 
to the opening of hydarthrosis with the cautery — an operation which is 
still performed by horse-shoers and empirics. Already Garsault and 
a number of others of the last century, passed, through thoroughpins, 
setons animated with " ointment of scarabee." The puncture with the 
bistouri has counted many convinced advocates. In 1826, Cross 
addressed the Societe Ccntrale {f Agriculture with a paper on the 
" Recovery of Dropsies by Puncture with the Bistouri." Dard, Roettger, 
Fischer operated often that way and completed the operation by a band- 
age and a blistering friction. 

These primitive methods have caused many " disasters " : often they 
promoted articular inflammation, which soon cools down the most 
enthusiastic. To be useful and harmless, the puncture must be capillary 
and made in conditions of perfect asepsy. The skin should be shaved, 
washed, disinfected. On the prominent point of the hydarthrosis, the 
aseptic trocar should be thrust in the synovial, by a sudden motion of 
terebration. It is not necessary to make the puncture subcutaneously, in 
which the instrument, after running through the skin, passes in the 
cellular tissue, one or two centimeters, before entering the synovial. As 
soon as the rod is taken off, the fluid escapes through the canula ; smalL 
squeezes over the tumor stimulate the flow. With a Dieulafoy or a 



HYDARTHROSIS. 559 

Potain the serous is more completely emptied. The synovia returns 
rapidly, but ordinarily in less quantity ; successes have been obtained 
with simple repeated punctures. However, in the majority of cases, 
puncture is completed by compression, blistering, cauterization or modi- 
fying injections. We generally add to it the lines or deep points firing, 
according to the seat and dimensions of the hydarthrosis. 

To change the condition of the synovial, it has been injected with 
various fluids. For a long time, the operation has seemed most dan- 
gerous. Bouley said : " Knowing the alterations, often irretrievable, 
that the inflammation may produce when it occurs in those parts, spe- 
cially after a traumatic lesion, it is difficult to believe that injections, no 
matter of what nature and how carefully they may be made, would 
give rise to an inflammation limited only to the necessary degree 
required to modify the secretion of the synovial membrane and still 
remain unable to alter the structure of the parts." We will not give the 
technic of the operation ; it is already done. (See Dropsies of Tendinous 
Syjiovials). Among the agents used, tincture of iodine is the most in 
vogue. Leblanc and Thierry, after experimenting with it on animals 
and having obtained good results, recommended the injection of tincture 
of iodine to the third (tincture i part, water 2), for hydarthrosis as well 
as for tendinous sheaths. Serious accidents were soon recorded in 
Alfort, by Bouley ; at Lyon, by Rey ; at Toulouse, by Lafosse, then by a 
number of practitioners. These unfortunate results caused the iodine 
injection for the treatment of hydarthrosis to be put aside ; but they 
took place at the time when asepsy was ignored. With it, the method 
succeeds. 

Schede has made known the first successes obtained in man by the 
articular washings with strong phenic acid. Many surgeons who employ 
this method have found it excellent, and the operation of Schede has 
received its " clinical consecration." The following observation of 
Labbe deserves to be mentioned. A man thirty-one years old suffered 
for seven years with hydarthrosis of the knee. When the author was 
called, the articulation was enormous, distended by a great quantity of 
fluid ; the muscles of the thigh were much atrophied. Puncture was 
made with a large hydrocele trocar ; 4 liters of phenicated water, 5 p. 
100, were used to wash the joint thoroughly; the puncture was closed 
with collodion taffetas and the joint wrapped in a thick wadded bandage, 
tighly applied ; the whole leg was held in immobility. Eighteen days 
later, " the knee had resumed its normal aspect. The outlines of the joint 
were as well marked as those of the healthy articulation, a condition 
"which had not existed for seven years." 

Sometimes a trocar of some large dimension has to be used to permit 



560 VETERINARY SURGICAL THERAPEUTICS. 

the escape of the clots that the iodine or phenic acid make with the 
synovia, and which sometimes prevent the washing. So as to prevent 
the coagulation, Nocard has recommended solutions of thymic acid 
I or 2 p. 1000. 

Starting from this fact, that ergotine and morphine " reduce secre- 
tions," Laffitte has tried a mixture of equal parts of the two following 
solutions : 

Ergotine i gramm. 

Distilled water 40 do 

Muriate of morphia 0.50 

Distilled water 35 do 

Stottmeister has advised solution of eserine i p. 100 (5 to 10 grammes 
to a dose). 

After these modifying injections, moderate pressure (flannel, linen or 
rubber) with immobilization, or a blistering friction, can be used. Like 
Bassi, many practitioners prefer the blister to the bandage. 

Against hydarthrosis which have resisted penetrating firing and modify- 
ing injections, arthrotoiny can be resorted to. It comprehends the same 
rules as synoviotomy. The region, material of operation, surgeon and 
assistant must be thoroughly aseptic. Hemostasis is obtained with a 
rubber cord. With an incision made parallel to the large vessels and 
nerves, the synovia is allowed to escape, the false menbranes are removed, 
and the synovial membrane carefully cleaned out. Sometimes a piece 
of skin has to be excised on both edges of the wound. This is closed 
by sutures ; a drain is left at the lower commissure ; and the region 
covered with an antiseptic bandage, and immobilized as much as pos- 
sible. This is a delicate operation, which exposes to most severe com- 
plications, if asepsy has failed. Gunther and MoUer have condemned 
it. Notwithstanding some late success, their judgment needs no 
revision. We can only repeat what we have said on tendinous dropsies 
in general ; in the ordinary circumstances of our medicine, if one does 
not wish to run big risks, let him continue and prefer the cautery to the 
bistouri ; leave arthrotomy to the virtuoso and the lover of cutting. 

Let us resume the therapeutics of hydarthrosis. At the beginning, 
prescribe rest, douches, cold baths, astringents, compression, massage. 
If these fail, use blistering and again hydrotherapy and massage. 
When the dropsy is abundant or already old, and the peri-synovial tissues 
indurated, resort to firing in lines, in fine points or in needles. 



HYDARTHROSIS. $6t 

Hydarthrosis of Extremities. 
/. — Scapiilo- Humeral Joint. 

Although very extensible, the synovial of the shoulder-joint does not 
protrude externally when it is dropsical. This condition is accused by- 
lameness and stiffness of the ex- 
tremity, which is carried forward 
with difficulty ; in some cases, the 
point of the shoulder is deformed 
by a diffuse swelling. The sheath 
•of the coraco-radialis, which, in 
solipeds, is independent of the 
scapulo-humeral synovial, may be 
the seat of a synovitis, sometimes 
mistaken for the lesions of the 
articulation. 

Lines or deep points firing is 
the only beneficial treatment. 

" In tetradactyles, dropsy of 
the articular capsula may be 
manifested by a double soft 
tumor, which appears on both 
sides of the coraco-radialis mus- 
cle, that is, at the antero-inferior 
part of the point of the shoulder. 
The reason is that the ca,psula 
extends downwards and forwards, 
to line the internal face of the 
muscle in question, and that it 
is not longer sufficiently pro- 
tected on the sides of this muscle, 
to be prevented from distending 
on this point when it becomes the seat of a dropsy " (L. Lafosse). 

Cauterization is also the choice treatment. 




Fig. 114. — Hydarthrosis of the elbow 
(from a photograph. ) 



tl. — Elbow Joint. 

In his Traite de Pathologic, Lafosse wrongly states that this joint is 
never the seat of hydarthrosis. We have seen two cases of it at the 
Alfort clinics ; many practitioners have related examples of it. Here is 
the resume of one of our observations : 

Five-year-old horse, working for six months. When shown to us, its; 



562 



VETERINARY SURGICAL THERAPEUTICS. 



gait is shorter for some time. At rest, the left anterior leg is held 
forward of the plumb line, resting on the plantar surface ; in walk- 
ing, the movements of this leg seem stiff, and when the animal is tired,, 
lameness appears. Towards the inferior part of the mass of the exten- 
sors of the forearm, at the external face of the elbow, on a level with 
the tendon of origin of the- external flexor of the metacarpus, there is 
seen a bi-lobulated tumor whose great axis, measuring 12 centimeters, 
was running obliquely downwards and forward. 
Both dilatations, separated by a slight depression, 
were hard, tense, when the leg was resting ; they 
became less apparent and softer as soon as the leg 
was flexed. It was a hydarthrosis of the elbow, a 
distension of the cul-de-sac which lines the tendon 
of the external flexor of the metacarpus ; the inferior 
dilatation had taken place in front, the other back 
of this tendon (fig. 114). With a capillary trocar, 
an aseptic puncture was made on the lower jDouch, 
which allowed the escape of about 150 grammes 
of synovia. A blister was applied on the external 
face of the joint. Three weeks after, the dropsy 
had returned, causing a great stiffness of motion. 
With a new aseptic puncture and a deep pointed 
firing on the external face of the elbow, the hy- 
darthrosis disappeared completely and the leg 
recovered the entire freedom of its movements. 

/// — Carpal Articulations — Articular Thoroughpins 
of the Knee. 

Besides the ligaments proper to each one, carpal 
articulations are held together by four common 
ligaments, which allow the distension of the synov- 
ials that line them, to take place only in given 
parts. The radio-carpal hydarthrosis is shown by 
the existence of two tumors : one, round in form, 
from a nut to a man's fist in size, is situated on the external face 
of the region, a little above the trapezium, between the posterior face 
of the radius and the external flexor of the metacarpus (fig. 115); 
it is formed through the narrow solution of continuity which exists 
between the posterior common and the radio-suscarpal ligaments ; 
old, it is often indurated or calcified. The other occupies the anterior 
face at the junction of the knee and the forearm. Hydarthrosis of the 
intercarpal joints gives rise to two or three hemispherical tumors^ 




Fig. 115. — Hj-darth- 
rosis of the knee 
(from a photo- 
graph.) 



HYDARTHROSIS. 565 

situated towards the middle of the anterior face of the knee between the 
extensor tendons ; tense when the leg is at rest and simulating exostosis, 
they are soft and fluctuating when the leg is raised, unless their walls 
are indurated or calcified. As to the carpo-metacarpal synovial, nar- 
rowly supported by the ligaments surrounding it, it can be the seat of no 
distension visible externally. 

The radio-carpal hydarthrosis, by far the most frequent, is well char- 
acterized by the tumor resulting from the dilatation of its external cul- 
de-sac ; that produced by the distension of the carpal tendinous sheath, 
less circumscribed and situated more backwards, alongside the deep 
flexor of the phalanges, co-exists with an elongated, cylindrical tumor, 
which occupies the superior third of the cannon and surrounds the 
tendons. It is easy to differentiate the intercarpal hydarthrosis from 
the dropsies of the sheaths of the tendons, which are more superficial 
and elongated in the axis of the leg. For the hygroma of the knee, its 
situation is subcutaneous. 

It is again with blisterings and firing, sometimes also by puncture, 
that those hydarthrosis are treated. The radio-carpal hydarthrosis is 
more accessible to trocar, and the inter-carpal nodosities, less voluminous, 
disappear ordinarily with deep firing if applied early. 

In cattle, Latffite has proposed the use of injections of morphine and 
ergotine. But in those animals, as in horses, cauterization is the in- 
dication. 

IV. — Coxo-Femoral Joint. 

The large muscles which surround the hip- joint do not allow much 
dilatation of the synovial. However, Vitet and Rigot admit the exist- 
ence of this hydarthrosis. We have related the observation of Vitet, in 
which the relaxation of the joint by the accumulation of synovia was so 
marked that the head of the femur would slip out of the cotyloid cavity. 

The diagnosis of these lesions is difficult, exceptionally rare ; they 
interest the anatomo-pathologist more than the practitioner. Sub- 
cutaneous firing would be the therapeutic means of choice. 

V. — Femoro-Tibio-Patellar Joint. — Patellar Thoroughpin. 

The stifle joint has three synovials : one superior and two lateral. 
The first, very large, supported by the femoro-patellar capsula, helps 
the gliding of the patella upon the femoral pulley and extends in cul- 
de-sac under the insertion of the triceps cruralis. The two others, that 
lubrify the articular surfaces of the femoro-tibial joint, line the posterior 
ligament, the laterals and the fibrous fasciculi that attach the menisci 



564 VETERINARY SURGICAL THERAPEUTICS. 

The external of these cul-de-sacs covers, besides, the tendon of the 
popliteus and furnishes a small prolongation which runs down the 
groove of the tibia to envelop the tendon common to the anterior 
extensor of the phalanges and the flexor metatarsi. These two synovials 
communicate quite frequently, not to say always, with the femoro- 
patellar synovial. All three are separated from the tibio-patellar liga- 
ments by a mass of adipose tissue (Chauveau and Arloing). 

Patellar hydarthrosis is characterized by a diffused swelling of the 
stifle, more accused inside than outside ; the tibio-patellar ligaments are 
less distinct and concealed by an elastic swelling. Flexion of the joint 
is difficult, the leg is stiff, its movement forward very limited. 

This hydarthrosis seldom gives away to blistering applications. 
Dandrieu (1836) said he obtained a rapid success by puncture with a 
bistouri, but an attentive reading of his article seems to show that the 
author had a subcutaneous sero-fatty collection to deal with, instead 
of a hydarthrosis. Chariot and Valtat, after opening the synovial 
with a bistouri, have seen a fatal arthritis occur. We generally treat 
this disease by an aseptic puncture with a trocar and with firing in 
lines, fine points or needles. That is the treatment that Viseur recom- 
mended in 1875. T'^^ Observation I. of his paper relates to a patellar 
thoroughpin which had resisted several treatments ; the tumor was 
voluminous, tense, painful on pressure ; in walking, the animal dragged 
the leg with a movement of circumduction. Puncture was made with a 
trocar of small caliber ; on the flattened tumor, " a deep pointed firing 
was applied, through the skin only, as in Leblanc's method," and its 
action completed by a blister. In fifteen days the subject received 
walking exercise. Shortly after, the lameness disappeared and the 
horse resumed his work. On another subject, the same result followed 
the same treatment. We could add numerous facts as evidence of the 
efficacy of this method. 

The injection of iodine, used unsuccessfully by Rey, has given good 
results to Verrier. On a two years' colt (Obs. IX of his report), suffering 
with very large patellar hydarthrosis, two injections had to be made 
some time apart ; there was no complication ; after three months 
recovery was complete. In case of failure after puncture followed by 
firing, washing by the method of Schede might be resorted to. In 
several cases, Mollereau has used with advantage a solution of thymic 
acid at 2 p. 1000. 

In horses and dogs the femoro-tibio-patellar joint is quite frequently 
affected with arthritis deformans, clinically manifested by lameness, 
stiffness of the leg, bony neoformation on the articular extremities 
and often also, in horses, with a certain degree of hydarthrosis. The 



HYDARTHROSIS. 565 

careful examination of the diseased joint allows the diagnosis. The 
prognosis of this arthritis is always more serious than that of the sim- 
ple patellar thoroughpin. It resists all treatment. (See Arthritis De- 
formans.^ 

VI. — Tarsal Joints — Articular Thoroughpins of the Hock. 

Due to dropsy of the tibio-tarsal synovial, this hydarthrosis is char- 
acterized by three tumors, fixed in their location but varying in their size. 
One of them occupies the antero-internal region of the hock ' ; two are 
situated behind, between the tibia and the calcanean cord, above the 
lateral ligaments ; one of these last can be absent ; the other, existing 
with the anterior, characterizes well the articular thoroughpin, which is 
generally more frequent than the tendinous. 

At the beginning, cold water, astringents, massage, tincture of iodine 
-externally may be useful. Halley has recommended setons under the 
skin, carefully avoiding the synovial ; this is dangerous and not used. 
Ordinarily, blisters are used. For a certain number of cases, their 
application is followed with a marked diminution in the size of the 
tumors ; but the most recommendable treatment is cauterization, firing 
in lines or penetrating points. Horn allows the escape of the synovia, 
and then applies a compressive bandage on the hock. 

Intra-synovial injections have been advised by Leblanc. In 1861 he 
published facts showing the efficacy of injections of iodine. The 
patient of his Observation I. had an enormous hydarthrosis ; two in- 
jections had to be made a month apart ; recovery was complete. In 
Observations II. and IV. the subjects had to be treated twice; with, 
them also the dropsy disappeared in a few months. Abadie and Dupont 
have obtained many times good results with injections of iodine. But 
Bouley, Rey, Lafosse, Verrier and others have had accidents. Bouley 
tried this treatment in a horse affected with a large thoroughpin, from 
which eight deciliters of synovia were removed through the puncture ; a 
solution of one part of tincture of iodine against three of water was in- 
jected ; part of it only could be removed, albuminous clots having closed 
the canula. A high fever followed ; six days after, the animal was unable 
to rest on his leg, pain was excessive ; a puncture was made on the ex- 
ternal tumor, from which escaped a yellowish fluid, already purulent. 
Multiple abscesses formed round the joint. Twelve days after the horse 
died. With him ended the treatment of articular thoroughpin by injec- 
tions of tincture of iodine. To this day, phenic acid, thymic acid, have 
not been much utilized ; no more than other antiseptics. Zimmer is said 

1 The blood-spavin of English. 



566 VETERINARY SURGICAL THERAPEUTICS. 

to have obtained good results with puncture and the injection of subli- 
mate corrosive I p. I GOO followed by a blister. 

Laffitte in 1886 has said much in favor of a mixture equal parts of: 
solutions of ergotine and muriate of morphia. His Observation I relates, 
to a bull which had a large thoroughpin which had resisted blistering ;., 
the injection made, the wound was closed with a stitch, a compressive- 
bandage was applied on the joint ; a month later, recovery was complete.. 
A heifer and a mare were cured by the same method. 

The "baring of the veins" has been advised, 
— a fantastic operation consisting in ligating- 
the vein: ist, below the bony projection where 
spavin grows ; 2d, on the inside of the leg, im- 
mediately below the small venous branch coming 
from the anterior tibial muscles. When both 
ligatures are applied the vessel is open in its- 
whole length between them. A quite abundant 
hemorrhage takes place, which when it stops 
indicates the end of the operation. Slight pres- 
sure and tepid lotions on the joint continue the 
treatment. 

This fantastic operation is said to have been 
successful in colts. But it must be remembered 
that with them thoroughpins disappear as the 
animal gets old. If the treatment has any effect 
it must be only by the local irritation it produces. 
Gloag has treated hydarthrosis of the hock by 
acupuncture : two seatings, live days apart ; the 
last followed by an application of tincture of 
iodine and a compressive bandage. 

Puncture followed by lines or penetrating 
pointed firing is the select mode of treatment. 

Fis 116— Hvdarthro- ^-^-^- — Articulations of the Fetlock a7id Foot — 
sis of the fetlock. Articular Windgalls. 

The articular synovial of the fetlock is strongly protected in front and' 
on its lateral faces. Its hydarthrosis is accused by two dilatations, sit- 
uated above the sesamoids, between the cannon bone and the suspen- 
sory ligament ; one on the inside, the other on the outside. These 
tumors, whose dimensions are rarely larger than that of a large nut, are? 
hard when the leg is at rest, soft and fluctuating when it is raised. Withi. 
profuse dropsy there is also in the pastern, along the middle and super- 




DRY ARTHRITIS— ARTHRITIS DEFORMANS. $6/ 

iicial sesamoid ligaments, several smaller nodosities. In time the peri- 
:synovial tissues become indurated, calcified or ossified. 

The treatment comprises : At first, antiphlogistics, compression, 
massage or blisters ; later, puncture with firing in lines, fine points or 
needles. In rebel cases, with asepsy, injections of phenicated water 
(3-5 p. 100) or of sublimate (i p. 1,000) might be attempted. Imme- 
diately after the operation a wadded dressing or a roller of rubber should 
he applied. 

The syjiovial of the foot may dilate on the level of its lateral culs-de- 
sac and constitute two little windgalls above the cartilages. Their sym- 
metrical position, their tense condition when the animal is at rest, their 
softness when the foot is raised, are sufficient to distinguish them from 
cysts and side bones. 

Generally they give rise to no lameness and demand no treatment. 
If they did, blisterings, or firing if those are insufficient, must be re- 
sorted to. 

IX. 

DRY ARTHRITIS— ARTHRITIS DEFORMANS 

Quite common in horses, cattle and dogs, dry or dcfot-fnans arthritis' 
may affect all joints. Anatomically it is specially characterized by the 
wearing of diarthrodial cartilages, the production of osteophytes and the 
deformity of articular surfaces. The affection is sometimes mono-articu- 
lar, limited to one joint ; at others polyarticular. Goubaux has seen it in 
all the joints. It is relatively frequent in the hock, knee, fetlock and 
coronet (Stockfleth). Dry arthritis of the knee gives rise to some of the 
osselets ; that of the hock promotes the most serious variety of spavins ; 
that of phalangeal joints, number of ringbones. We have often observed 
it at the stifle in horses and dogs ; it is more common in heavy horses 
and large dogs ; sometimes it is unilateral, at others the two joints are 
affected. Dry arthritis of the hip is rarer ; we have seen a few cases in 
dogs; Moller and Siedamgrotzky have seen it in'the horse. At the 
museum of the veterinary school at Berne there is a skeleton in which 
almost all the joints are affected. At the autopsy of a horse treated 
without success for a " general stiffness " of the four legs, Niebuhr found 
all the joints diseased. Sticker has recorded a similar case. 

The nature of dry arthritis is yet in discussion. In man, the rheuma- 
toid origin has been sustained by Charcot. For Weber it is the result 
of a lesion of the spinal cord and of the nerves. But traumatic lesions, 
such as luxations, can end with arthritis deformans. According to 
•Quenu, it "is not a special disease; it is a mode of termination of all 



568 



VETERINARY SURGICAL THERAPEUTICS. 



species of chronic arthritis, whether it is due to rheumatism, trauma- 
tism, or even through a disease of the nervous system. Arthritis defor- 
mans would be a possible result of most of the arthropathies ; its physiog- 
nomy would be due less to the primitive nature of the arthritis than to the 
general nutrition of the subject and the local condition of the affected leg.' 




Fig. 117. — Dry arthritis of the stifle joint (from a photograph). 

Monoarticular, they sometimes have a traumatism for cause ; polyar- 
ticular, it is ordinarily related to a general affection. The lesions^ 
always characteristic, are the result of two simultaneous processes : one 
destructive, producing the elimination of the epiphysar cartilages and the 

^Quenu: Traite de Chirurg. de Duplay and Reclus, t. III., p. 414. 



ARTHROPATHIES IN NERVOUS AFFECTIONS. 569 

■wearing of the bony surfaces ; the other productive, bringing the forma- 
tion of cartilaginous vegetation (ecchondromas) or osseous (osteo- 
phytes). The epiphysar cartilages undergo the velvety change ; their 
central portion, which receives the greatest pressures, is eliminated. 
The bony surfaces that are in contact become eburnated, ivory-like or 
marked with fissures. At the periphery, cartilaginous neoformations, 
which soon ossify, are seen. The ligaments, articular capsula and mus- 
cles contribute also to the formation of these bony deposits. If some- 
times there is synovial hypersecretion, it is ordinarily a rule to find in the 
joint only a very small quantity of thick, reddish fluid ; sometimes even 
the dryness of the joint is complete. The serous is generally red, vas~ 
cular, covered with villosities. Articular foreign bodies are frequent. 
The interarticular ligaments, meniscus (stifle and temporo-maxillary 
articulation), are always much altered, sometimes entirely destroyed. 

For articulations that can be easily explored, the deformity of the 
joint, the slow development of the process, its chronicity, allow the diag- 
nosis. In the horse and dog the femoro-patellar dry arthritis is easily 
made out. The animal is lame on one hind leg, and on exploring it the 
stifle is found voluminous and the articular extremities swollen. 

The march of the disease is continued and progressive ; prognosis 
almost always fatal. Yet, working animals can be used at slow work 
(walking) for a more or less long time. 

Blisterings, intrasynovial injections, firing, fail just as much as cold, 
hot moisture, compressions or massage. In dogs, we have obtained some 
slight improvements with needle firing. In horses, if the disease was 
located on the lower regions of the legs (knee, fetlock, coronet, foot), 
neurotomies might permit the utilization of the subjects for some time 
longer. 

X. 

ARTHROPATHIES IN NERVOUS AFFECTIONS. 

The influence of the nervous system upon the nutrition of bones and 
articulations is yet little known. Experimentation has shown, however, 
that simple nervous sections are rarely followed by osteopathies and 
arthropathies. Those would rather occur when neuritis or myelitis come 
to complicate the nervous trauma. Exceptional in animals, they are 
frequent in man after pricks, shotgun wounds and others accompanied 
with neuritis. Various affections of the spinal cord (traumatisms, com- 
pression, chronic inflammation, locomotor ataxia) or of the brain (hem- 
orrhage, softening, tumors) may also give rise to arthropathies. 

Treatment is that of the causal affection. No local interference can 
do any good. 



570 VETERINARY SURGICAL THERAPEUTICS. 

XL 

FOREIGN BODIES. 

We will not speak here of the foreign bodies coming from outside 
(projectiles or any other sharp metallic substances) ; but only of those 
that develop in the synovial or the parasynovial tissues. Arthrophytes 
are rare in animals ; they have seldom been observed, except in 
horses. Goubaux has found them in the femoro-patellar, tibio-tarsal 
and temporo-maxillary joints ; Bruckmiiller in those of the shoulder 
and elbow ; Rolofif in the hock ; Stockfleth in the hock and in the knee. 
Moller has made them out in the knee during life. We have observed 
them in the knee, fetlock and stifle joint. The bodies exist specially 
in adults or aged subjects. Sometimes also in young animals. Stock- 
fleth has seen them in the hock of a six months' colt. 

If their pathogeny is still doubtful, it is now known that their origin 
varies. The riziform granules, which we have mentioned in tendinous 
synovials, in hygromas, seem to result from the inflammatory exudate 
deposited on the surface of the synovial. Free or pedunculated, the or- 
ganized foreign bodies are of fibrous, fatty, cartilaginous, osteo-carti- 
laginous or bony nature. Most often, they are connected with dry arthri- 
tis and all the tissues of the joint seem to be able to give rise to them. 
There are arthrophytes of traumatic origin which are only pieces of 
normal tissues torn from the epiphysis by blows, knocks or any other 
traumatic actions. They have been seen ready to get loose from the 
articular surface to which they were attached only by a single peduncle. 
Sometimes they are single, or again exist in various numbers. Their 
volume varies ordinarily between that of a shot to that of a pea ; ex- 
ceptionally they may be as big as a pigeon's egg. Most of them are 
rounded, sometimes having one depression resembling a hilus. In ani- 
mals, foreign bodies of synovials have no relation to tuberculosis. 

These bodies may remain a long time in synovials without producing 
any disturbance ; but it happens — no doubt when they engage them- 
selves between the articular surfaces, under a ligament or a tendon — 
that they give rise to sudden lameness varying in duration. All of a 
sudden, while at work, the animal goes on three legs ; the lame leg is 
stiff, as if there was a luxation ; there is great pain. These symptoms 
subside all at once or only little by little. In a superficial joint, pal- 
pation, carefully made, might permit the diagnosis. 

When this is made, if there are serious troubles and interference 
is necessary, several processes present themselves : by acupuncture, 
several pricks are made on the foreign body ; it is irritated, its disag- 



FOREIGN BODIES. 



571 



gregation is attempted ; success is very uncertain. Needles firing has 
given some results. H\\q fixation of the arthrophyte to the capsula, or a 
part outside of the articular surfaces, has been recommended. The animal 
kept standing, with the fingers the foreign body is brought to the selected 
part and fixed, with a very fine steel peg. The region is then immobil- 
ized. After five or six days, the adhesion is perfect, the steel peg is 
removed. The articular inflammation resulting from this manipulation 
is treated by cold. This method has but few advocates ; it is difficult 
to find a " convenient spot "to fix the arthrophyte. 




Fig Ii8. — Dry arthritis of the stifle joint. Articular surface of the tibia, c, 
foreign osteo-cartilaginous body attached to the synovial by a peduncle. 
(From a photograph. ) 



Extraction remains the select operation. But it is delicate in animals ; 
to safely hold the foreign body during the incision, anesthesia is neces- 
sary, and the opening of the articulation exposes it to suppurative 
arthritis : it demands a severe asepsy. Here is the modus operandi. 
After careful disinfection of the joint, the foreign substance is held 
fixed with the left hand or the fingers of an assistant. Over it, the 
operator incises all the peri-articular tissues in avoiding large vessels 
and nerves. The synovial must not be open until hemostasis is made 
on the edges of the wound, so as to avoid the introduction of blood into 
the joint. The arthrophyte may enucleate under the pressure of the 
£ngers or be extracted by forceps. The edges of the wound are closed 



57-2 VETERINARY SURGICAL THERAPEUTICS. 

by stitches, and the whole covered with iodoform or iodoformed collodion^ 
with a wadded dressing, insuring the immobilization of the joint. 

Let us add that, in general, as these products exist in articulations 
already much altered, interference is followed only by poor results or 
perhaps none at all. 

XII. 
ANKYLOSIS. 

In those morbid conditions, always secondary, joints have lost the 
whole or part of their normal movements. Between the simple articular 
fissure and the complete union of bony extremities, there are numerous 
intermediates. In every ankylosed joint, the various tissues co-operate 
for a certain portion, to immobilization ; bones, synovials, ligaments^ 
aproneuosis, muscles and the skin itself. Even nerves and blood-vessels 
are retracted. 

Pathological anatomy has recognized : i, tnie or complete anky- 
losis, in which the articular surfaces and the ligaments are interested ; 
•2, false or incomplete, due to alterations of the peri-articular tissues. 

Clinic has not accepted this division ; it has been observed that 
lesions of the articular surfaces and ligaments permit sometimes ex- 
tensive movements, while peri-articular alterations can immobilize a 
joint completely. For this reason, to-day, true or complete ankyloses are 
those where no motion whatever is allowed; \\h.\\Q false or incofnplete 
arethose which reduce more or less the extent of the normal movements. 

In complete ankylosis, there is : i, the interstitial bony ankylosis or by 
J'usion, ordinarily following suppurative arthritis, sometimes dry ar- 
thritis (spavin), and characterized by the disparition of the articular cavity^ 
the union of the bony extremities uncovered of their cartilages ; 2^ 
peripheric ankylosis or by bony layers, very frequent in animals, and pro- 
duced by the ossification of the peri-articular tissues and specially the 
ligaments. The cartilages and the synovial generally remain intact. 

In the incomplete ankylosis there is also a division into intracapsular^ 
due to plastic products, organized in the interior of the cavity, and ex- 
tracapsular, produced by the retraction, induration or calcification of the 
peri-articular structure. 

Frequently these various lesions are found in one ankylosis. 

The prophylaxis of ankyloses consists in the rational treatment of the 
different diseases which it follows (articular or epiphysar fractures, acute 
or chronic inflammation of joints, serious wounds round articulations). 
If for all those immobilization is the first condition of recovery, if kept 
too long it promotes retraction of tissues and predisposes to ankylosis- 



ANKYLOSIS. 575 

Complete immobilization being difficult to realize in animals, ankylosis is 
less feared than in man ; however, during convalescence of arthropathies, 
it is indicated to submit the region to massage, and utilize douches, 
baths and exercise. 

With incomplete ankylosis, it is again to the same means that one 
must resort : massage, hydrotherapy, moderate exercise, or passive 
action made with the hands and frequently repeated. 

In large animals, complete ankylosis is incurable. For those of the 
knee, elbow, shoulder, hock, stifle, nothing can be done. High and 
double neurotomy, that of the median or sciatic, may be tried for true or 
false phalangeal ankylosis. 

With small species the curative therapeutics can go further. If mas- 
sage, mobilization, exercise fail ; if the ankylosis made in bad position 
interferes with locomotion, the means used in human surgery can be 
resorted to for animals. The sudden straightening is better than the 
progressive. Under anesthesia, the bones will be forced into good 
position by violent traction or by subcutaneous tenotomies. If there 
is complete bony ankylosis, it must be broken (arthroclasia). To create 
a false articulation by osteotomy or to resect the articular extremities 
are more complex means, to this day not used in veterinary surgery. 



INDEX 



PAGE 

A 

Abscess loi 

Accidents from lightning 163 

Achillis, wounds of the Ten.do. . . 2S7 

Acne 239 

Actinomycosis 200 

Acute synovitis, closed 327 

Adenitis 377 

Amyotrophies 273 

Anaesthesia, general 28 

local ... V 43 

of the horse 30 

with ether 30 

with chloroform 33 

with chloral 36 

of ruminants and swine 39 

of dogs and cats 39 

of monkeys 41 

of birds 42 

by cold 43 

by cocaine 44 

Aneurisms 353 

arterio-venous 355 

Animals, means of restraint of .. . i 

Ankylosis 572 

Anthrax 240 

bacterian 207 

bacteridian 208 

Antisepsis and asepsis 46 

Antisepsy and asepsy, technic of. 57 

Antiseptic agents 52 

Anterior extensor of the phalan- 
ges, rupture of 301 

Aponeurosis, diseases of 345 

Arteries, diseases of 347 

rupture of 351 

wounds of 347 

Arteritis and thrombosis 357 

676 



Arthritis, traumatic 533 

traumatic, of extremities 535 

closed idiopathic 545 

infectious 546 

of milch cows 549 

post partum 549 

of new boms 552 

dry . • • • 567 

deformans 567 

Articular rheumatism 548 

thoroughpin of the knee 562 

windgalls 566 

wounds 535 

Articulations, diseases of 491 

contusions of 49 1 

sprains of 491 

wounds of 523 

Arthropathies 569 



Bacterian anthrax 207 

Bacteridian anthrax 208 

Birds, anaesthesia of 42 

Bones, diseases of 412 

contusions of 412 

wounds of 413 

Boms, new, arthritis of 552 

Botryomycosis 204 

Bruises 150 

Burns 157 

Bursitis 248 



Cannon, hygroma of 259 

Capped hock 257 

Caries 459 

Carpal joint, hydarthrosis of 562 

Carpus, fracture of 441 



576 



INDEX 



Casting with hobbles 9 

without hobbles 17 

Cattle, restraint of 20 

restraint of, standing 20 

Cat, anaesthesia of the 39 

Cauterization 77 

of solipeds 79 

of bovines 92 

Chilblains 152 

Chloroform, anaesthesia with .... 33 

Chloral, anaesthesia with 36 

Chronic septicemia 183 

Chronic synovitis 338 

Cicatrices i94 

Closed acute synovitis 327 

Closed idiopathic arthritis 545 

Cocaine, anaesthesia by 44 

Cold, anaesthesia by 43 

Complete fractures 415 

Complications of traumatic lesions 166 

Contused wounds 134 

Contusions, 150, 284, 369, 412, 491 

Contusions of tendons 284 

Coraco-radialis, synovitis of the 

sheath of the 333 

Cord of the flexor metatarsi, rup- 
ture of 297 

Cores 225 

Cows, arthritis of milch 549 

Coxo-femoral joint, sprain of ... . 497 

luxation of 511 

hydarthrosis of 563 

Cramps 276 

Cubitus, fracture of 440 

Cutaneous horns 242 

Curb 479 

D 

Deformans arthritis 567 

Dermatitis 229 

Diseases common to all tissues . . 97 

virulent 207 

special to aU tissues 225 

of skin and cellular tissue 225 

of serous bursae 248 

of muscles 261 

of tendons 284 

of tendinous synovial sacs. . . 324 
of aponeurosis 345 



PAGE 

Diseases of arteries 347 

of veins 36 1 

of lymphatics 369 

of nerves 382 

of bones 412 

of articulations 491 

Dog, anaesthesia of 39 

Dressing material 56 

Dry arthritis 567 

E 

Elbow, hygroma of the 251 

capped 251 

luxation of the 508 

hydarthrosis of the 561 

Ether, anaesthesia with 33 

Elephantiasis 237 

Erythema 227 

Excoriations . . . , 225 

Exostosis 465 

Extensors of phalanges, wounds 
of the tendons of 289 

F 

Farcy 209 

Femoral nerve, paralysis of the . . 407 
Femoro patellar joint, luxation of 515 
Femoro tibial joint, luxation of . . 514 

wounds of 539 

hydarthrosis of 563 

Femur, fracture of the 444 

Fetlock, hygroma of the 259 

Fetlock, sprain of the 499 

luxation of the 5J7 

wounds of the 54^ 

Firing 77 

Fistulae 117 

Foreign bodies 120, 570 

Fire arms, wounds by 137 

Frost bites 154 

Fever, traumatic 171 

Fibula, fracture of the 447 

Flexor metatarsi, rupture of the 

cord of the 297 

Flexor tendons of the phalanges, 

rupture of the 301 

Flexor tendons of the phalanges, 
wounds of the 289 



INDEX 



577 



PAGE 

Fractures 414 

incomplete 414 

complete 415 

open 429 

of the scapula 432 

of the humerus 435 

of the radius 437 

of the cubitus 441 

of the carpus 441 

of the ossa innominata 442 

of the femur 444 

of the patella 446 

of the tibia and fibula 447 

of the tarsus 449 

of the metacarpus 450 

of the metatarsus 450 

of the phalanges 452 

of the sesamoids 454 

Furuncle 240 

G 

Oangrene iii 

General surgery i 

anaesthesia 28 

Granular wounds 148 

Granulations 194 

Great sciatic nerve, paralysis of 

the 410 

Gun-shot wounds 137 

H 

Hemorrhage and traumatic anse- 
mia 167 

Hemostasis 69 

preventive 69 

during and after operation. . . 71 

Hernias 266 

Hobbles, casting with 9 

casting without 17 

Hock, synovitis of the 339 

sprain of the 498 

luxation of the 516 

wounds of the 540 

Horse, anaesthesia of the 30 

Hydarthrosis 554 

of the scapulo humeral joint . 561 

elbow joint 561 

carpal joict 562 



PAGE 

Hydarthrosis of the coxo-femoral 

joint 563 

femoro-tibial joint 563 

tarsal joint 565 

fetlock joint 566 

Hydatids 490 

Hygromas 24S 

of the elbow 251 

knee 255 

stifle 257 

hock 257 

fetlock 259 

cannon 259 

withers 260 

poll 260 

Humero - radio - cubital jointj 
wounds of the 536 

Humerus, fracture of the 435 



Idiopathic (closed) arthritis 545 

Incised wounds 130 

Incomplete fractures 414 

Infection, purulent 175 

putrid 183 

Infectious arthritis 546 

Inflammation 97 

Insolation i6r 

Instruments for dressings 56 



Jarde 



474 



K 



Knuckling 316 

Knee, hygroma of the 255 

synovitis of the 337 

sprain of the 497 

luxation of the 510 

wounds of the 537 

sprung 320 



Lesions, complications of trauma- 
tic 166 

traumatic 261, 324, 361, 382 

Local anaesthesia 43 

stupor 166 



578 



INDEX 



PAGE 

Luxations 266, 503 

tendinous 304 

of the long vastus 267 

shoulder 506 

elbow 508 

knee 51° 

pelvis 510 

coxo-femoral joint .... 511 

stifle joint 514 

hock joint 516 

fetlock joint 517 

phalangeal joint 520 

pseudo, of the patella 520 

M 

Means of restraint of animals i 

Metacarpus, fracture of the 450 

Metatarsus, fracture of the 450 

Monkey, anaesthesia of the 41 

Morphine, anaesthesia with 38 

Muscles, diseases of 261 

traumatic lesions of 261 

ruptures of 263 

Mycosis 200 

Myositis 269 

N 

Necrosis 461 

Nerf ferrure 306 

Nervous affections, arthropathies 

in 569 

Neuritis 39° 

Neuromas 392 

Neuralgias 395 

O 

Obturator nerve, paralysis of the. 407 

Open fractures 429 

Ossa innominata, fracture of the . 442 

Osselets 468 

Osteitis 455 

Osteo-arthritis, tarsal 469 

Osteoclastia 487 

Osteomalacia 487 

Osteomyelitis 455 

suppurative 459 

Osteoporosis 487 

Overheat 161 



PAGE 
P 

Paralysis 396 

of the sus-scapular nerve .... 401 

brachial plexus 402 

radial 403 

obturator 47 

femoral 407 

grand sciatic 4-0 

external sciatic popliteal 410 

Parasitic affections 245, 275 

Parasites 275 

Patella, fracture of the 446 

Patellar thoroughpin 563 

Pelvis, luxation of the 510 

Peri-articular wounds 524 

Periostitis 455 

Phalangeal exostosis 478 

Phalangeal joint, wounds of 542 

Phalanges, fracture of the 452 

Phalanges, sprains of the 502 

Phlebitis 364 

Poisoned wounds 143 

Poll, hygroma of the 260 

Post-partum arthrilis 549 

Preventive hemostasis 69 

Pricking instruments, wounds with 132 
Pseudo luxation of the patella . . . 520 

Punctured wounds 132 

Purulent infection 175 

Putrid infection 183 

Pyohemia 175 

Q 

Quittor, tendinous 292 

R 

Rachitism 404 

Radial nerve, paralysis of the 403 

Radius, fracture of the 437 

Restraint, means of. i 

in standing position • . 2 

while lying down 9 

of cattle 20 

standing 20 

in a recumbent position. . 23 

of small animals 25 

Rheumatism, articular 548 

Ringbones 478 

Ruminants, anaesthesia of 39 ■ 



INDEX 



579 



PAGE 

Ruptures 295, 351 

of muscles 263 

of the tendons of the infra- 
spinatus 296 

of the cord of the flexor meta- 
tarsi 297 

of the tendo Achillis 300 

of the anterior extensor of the 

phalanges 301 

of the flexors of the phalanges 301 
of the suspensory ligaments. . 303 
of arteries 351 

s 

Scapula, fracture of the 432 

Scapulo-humeraljoint, wounds of 535 

hydarthrosis of 561 

Sebaceous cysts 241 

Securing of solipeds 2 

Serous bursae, diseases of 248 

Sesamoids, fracture of the 454 

Shock 166 

Shoulder, luxation of 506 

Side bones 47S 

Small animals, restraint of 25 

Solipeds, cauterization of 79 

Spasms 276 

Spavin 469 

Specific lymphangitis 375 

Splints 476 

Sprains 491 

of shoulder joint 494 

of tendons 306 

of the shoulder 494 

knee 497 

hip 497 

stifle 498 

hock 498 

fetlock 499 

phalanges 502 

Springhalt 277 

Sprung knees 320 

Standing position, restraint in . . . 2 

restraint of cattle in 20 

Stickfasts 225 

Stifle, hygroma of the 257 

Stupor, local 166 

Subcutaneous wounds 149 

Sunstrokes 161 



I'AGK 

Suppurative tenositis 292 

Surgical antisepsis and asepsis ... 46 

Surgical septicaemia 178 

Suspensory ligament, rupture of. . 303 
Sus-scapular nerve, paralysis of. . 401 

Swine, anaesthesia of 39 

Syncope 166 

Synovitis, infectious 328 

chronic 330 

of the coraco-radialis 335 

sub-spinatus 339 

knee 337 

large gluteus 338 

hock 339 

sesamoids 341 

anterior extensors of 
phalanges 343 

T 

Tarsus, fracture of 449 

Technic of antisepsy and asepsy . . 57 

Tendo- Achillis, wounds of 287 

Tendons, diseases of 284 

Tendons, sprains of 306 

Tendon of infra spinatus, rupture 

of 296 

Tendons of the extensors of the 

phalanges, wounds of. 289 

Tendons of the flexors of the 

phalanges, wounds of 289 

Tendinous helminthiasis 322 

Tendinous luxations 304 

Tenositis 306 

Tenositis, suppurative 292 

Tetanus 184 

Thrombosis 170, 364 

Tibia, fracture of 447 

Torn wounds 141 

Traumatic lesions. . . 125, 225, 248, 261 
[324,361,382 

complications of 166 

lymphangitis 371 

synovitis 326 

anaemia 167 

emphysema 168 

venous embolism 170 

fever 171 

erysipelas 173 



58o 



INDEX 



Traumatic gangrene 178 

Tuberculosis 210 

Tumors 213, 243, 260, 275, 379, 489 

U 

Ulcers 115 

V 

Varices 367 

Veins, diseases of 361 

Venous embolism 170 

Virulent diseases 207 

W 

Withers, hygroma of 260 

Wounds 284, 347, 369, 413 

from sharp instruments 130 

from pricking instruments . . . 132 

contused 134 

by fire-arms 137 

gun-shot 137 



PAGE 

Wounds, punctured 132 

incised 130 

torn 141 

from bites 142 

poisoned 143 

virulent 143 

granular 148 

subcutaneous 149 

of the Tendo-Achillis 287 

of the extensors of phalanges 289 
of the flexors of phalanges .. . 289 

of articulations 523 

peri-articular 523 

penetrating 524 

of shoulder 535 

of elbow 536 

of knee 537 

of stifle 539 

of hock 540 

of fetlock 541 

of phalanges 542 



CATALOGUE OF 
WILLIAM R. JENKI^S• 

Works Concerning 

HORSES, CATTLE, SHEEP, SWINE, Etc. 

1906 



(*) Single asterisk designates New Books. 
(**) Double asterisk designates Recent Publications 



ANDERSON. "Vice in the Horse" and oLher papers 
on Horses and Eiding. By E. L. Andeisim. Size, 
6x9, cloth, illustrated 1 75 

ARMSTEAD. "The Artistic Anatomy of the Horse." 

A brief description of the various Anatomical Struc- 
tures which may be distinguished during Life through 
the Skin, By Hugh W. Armstead, M.D., F.K.C.S. 
With illustrations from drawings by the author. 
Cloth oblong, 10 x 12| 3 75 

BACH, " Hoiv to Jnd§:e a Horse." A concise treatise 
as to its Qualities and Soundness ; Including Bits and 
Bitting, Saddles and Saddling, Stable Drainage, Driv- 
ing One Horse, a Pair, Four-in-hand, or Tandem, etc. 
By Capt. F.W. Bach. Size, 5x7i, clo., fully illus.l 10 

OBANHAM. "Anatouiioal and Physiological Model of 

the Cow." Half life size. Composed of superposed 
platep, colored to nature, showing internal organs, 
muscles, skeleton, etc., mounted on strong boards, 
with explanatory text., Size of Model opened, 
10 ft. x 3 ft., closed 3 ft. x IJ ft 7 50 

— "Aratoniical and Physiological Model of the Horse." 

Half life size. By George A, Banham, F.K.C.V.S. 
Size of Model 38 x 41 in , , , 7 50 



2 Veterinary Catalogue of William R. Jenkins 

BA.NHAM (continued) 

— *' Tables of Veterinary Posolo^ and Therapeutics," with 

weights, measures, etc. By Geo. A. Banham, 
F.E.C.V.S. New edition. Cloth, size 4 x 5 1-2, 192 
pages 1 00 



BAUCHER. "Metliod of Horsemansliip." Including 
the Breaking and Training of Horses. By 
F. Baucher ; 1 00 



{*)BELL. "The Yeterinariau's Call Book (Perpetual)." 

By Roscoe R. Bell, D.V.S., editor of the American 
Veterinary Review. Revised every year. 

A visiting list, that can be commenced at any time 
and used until full, containing much useful informa- 
tion for the student and the busy practitioner. 
Among content'* are items concerning : Veterinary 
Drugs; Poisons; Solubility of Drugs; Composition of 
Milk, Bile, Blood, Gastric Juice, Urine, Saliva; Respi- 
ration; Dentition; Temperature, etc., etc. Bound in 
flexible leather, with flap and pocket 1 25 

BITTING. " Cadiot's Exercises in Equine Surgery." 

See "■Cadiot." 



BRADLEY. "Outlines of Veterinary Anatomy." 

By O. Charnock Bradley, Member of the Royal Col- 
lege of Veterinary Surgeons ; Professor of Anatomy 
in the New Veterinary College, Edinburgh. 

The author presents the most important facts of 
veterinary anatomy in as condensed a form as possible, 
consistent with lucidity. 12mo. 

Complete in three parts. 

Pabt I. : The Limbs (cloth) 1 25 

Paet II. : The Trunk (paper) 1 25 

Pakt III. : The Head and Neck (paper) 1 25 

The Set coMpiiETB 3 25 



651-S5d Sixth Avenue {cor. 48th St.), New York. 8 

CADIOT. " Exercises in Equine Surgery." By P. J. 

Cadiot. Translated by Prof. A. W. Bitting, D.V.M. 
Edited by Prof. A.. Llautard, M.D.V.M. Size, 6 x 9X, 
clotb, illustrated 2 50 

— ** Roaring in Horses." Its Pathology and Treatment. 

This work represents the latest development in oper- 
ative methods for the alleviation of roaring. Each 
step is most clearly defined by excellent full-page 
illustrations. By P. J. Cadiot, Professor at the 
Veterinary School, Alfort. Translated by Thos. J. 
Watt Dollar, M.R.C.V.S., etc. Cloth, size 5 1-4x7 1-S, 
77 pages, illustrated 75 

— "Studies in Clinical Veterinary Medicine and Surgery." 

By P. J. Cadiot. Translated, edited, and supplemented 
with 49 new articles and 3i illustrations by Jno. A. W. 
Dollar, M.E.C.V.S. Cloth, size 7x9 34, 619 pages, 
94 black and white illustrations 5 25 

(•)— " A Treatise on Surgical Therapeutics of the Domestic 
Animals." By P. J. Cadiot and J. Alray. Translated 
by Prof. A. Liautard, M,D.,V.M. 

I. General Surgery.— Means of restraint of animals, 
general aneesthesia, local ana3thesia, surgical anti- 
sepsis and asepsis, hematosis, cauterization, filing. 

II. Diseases Common to all Tissues. — Inflammation, 
abscess, gangrene, ulcers, fistula, foreign bodiep, 
traumatic lesions, complications of traumatic les- 
ions, granulations, cicatrices, mycosis, virulent 
diseases, tumors. 

III. Diseases Special to all Tissues ar;d Affections of 
the Extremities. — Diseases of skin and cellular tis- 
pue, of serous bursae, of muscles, of tendons, of 
tendinous synovial sacF, of aponeurosis, of arteries, 
of veins, of lymphatic.«, of nerves, of bones, of 
articulations. 

Cloth, size 6x9, 580 pages, 118 illustrations 4 £0 

CHAPMAN. "Manual of the Pathological Treatment 
of Lameness in the Horse," treated solely by 
mechanical means. By George T. Chapman. Cloth, 
size 6x9, 124 pages with portrait 2 00 

CHAUVEAU. "The Comparative Anatomy of the 
Domesticated Animals." By A. Chauveau. Revised 
by G. Fleming, F.il.C,V,S. 8vo, clpth, 585 illu8..6 25 



4 Veterinary Catalogue of Williavi R. Jenkins 

CLARKE. "Chart of the Feet and Teeth of Fossil 
Horses." By W, H. Clarke. Card, size 9 1-2 x 12. . 25 

— "Horses' Teeth.^' Fourth edition, re-revised, with second 
appendix. Cloth, size 5 1-4x7 1-2, 322 pp., illus..2 50 

CLEAVELiAND. "Pronouncing Medical Lexicon," 

Pocket edition. By C. H. Cleveland, M.D. Cloth, 
size 3 1-4x4 1-2, 302 pages 75 

CLEMENT. *' Veterinary Post Mortem Examina- 
tions." By A. W. Clement, V.!S. The absence in the 
English language of any guide in making autopsies 
upon the lower animals, induced Dr. Clement to 
write this book, trusting that it would prove of prac- 
tical value to the profession. Cloth, size 5x7 1-2, G4 
pages, illustrated 75 

(•*) CO UM TEN A r. ' ' Manual of the Practice of Veterinary 

Medicine." By Edward Courtenay, V. S. Revised by 
Frederick T. G. Hobday, F.ll.C.V.S. Second edition. 
Cloth, size 5 1-4x7 1-2, .^73 pages 2 75 

COX. " Horses : In Accident and Disease." The 

sketches introduced embrace various attitudes which 
have been observed, such as in choking; the disorders 
and accidents occurring to the stomach and intestines ; 
affection of the brain ; and some special forms of lame- 
ness, etc. By J. Roalfe Cox, F.R.C.V.S. Cloth, size 
6 X 9, 2S full page dlustrations 1 50 

CURTIS. "Horses, Cattle, Sheep and Swine." By 

Geo. W. Curtis, M.S. A. Cloth, size 7 1-4 x 10, 343 
pages, 1 17 illustrations 2 50 

{")DALRY3IPLE. "Veterinary Obstetrics." A compen- 
dium for the use of advanced students and Practi- 
tioners. By W. H. Dalrymple, M. R. C. V. S., 
principal of the Department of Veterinary Science in 
the Louisiana State University and A. & M. College; 
Veterinarian to the Louisiana State Bureau of 
Agriculture, and Agricultural Experiment Stations. 
Cloth, si-^e 6x9 1-4, 162 pages, 51 illustrations.. .2 50 



851-853 Sixth Avenue (cor. ^th St.), New York. 5 

DALZIEL, " Breaking ami Training Dogs." Part I, by 
Pathfinder. Part II, by Hugh Dalziel. Cloth, 
illustrated 2 50 

— " Tiie Collie." By Hugh Dalziel. Paper, illustrated ... 40 

— "The Diseases of Dog,s." Causes, symptoms and treatment. 

By Hugh Dalziel. Cloth, illustrated 1 tO 

— " Diseases of Horses." Paper 40 

— " The Fox Terrier." By Hugh Dalziel. Paper, 40 ; clo.l 00 

— "The Greyhound." Cloth, illus 1 00 

— " The St. Bernard." Cloth, illustrated 1 00 

DANA. "Tables in Comparative Physiology." By Prof. 
C. L. Dana, M.D. Chart, 17 x 17 25 

DANCE. " Veterinary Tablet." By A. A. Dance. Chart, 
17 X 24, mounted on linen, folded in a cloth case for 
the pocket, size 3 3-4 x 6 1-2. Shows at a glance the 
synopsis of the diseases of horses, cattle and dogs ; 
with their cause, symptoms and cure 75 

{*)DE BBUIN. "Bovine Obstetrics." By M. G. De Bruin 

Instructor of Obstetrics at the Slate Veterinary 

School in Utreclit. Translated by W. E. A. Wj'man, 

formerly Professor of Veterinary Science at Clemson 

A. & M. College, and Veterinarian to the South 

Carolina Experiment Station. Cloth, size 6x9, 382 

pages, 77 illustrations 5 00 

Syuopsis of tbe Essential Features of the Work 

1. Authorized translation. 

3. The only obstetrical work which is up to date. 

3. Written by Europe's leading authority on the subject. 

4. Written by a man who has practiced the art a lifetime. 

5. Written by a man who, on account of his eminence as 
bovine practitioner and teacher of obstetrics, was selected 
by Prof. Dr. FrOhner and Prof. Dr. Bayer (Berlin and 
Vienna), to discuss bovine obstetrics both practically and 
scientifically. 

(5. The only work containing a thorough differential dJaf.;- 
nosis of aL'te and post partum diseases. 



Veterinary Catalogue of William H. Jenkins 



DE BRUIN, " Bovine Obstetrics " (continued) 

7. The only work doing justice to modem obstetrical 
surgery and therapeutics. 

8. Written by a man whose practical suggestions revolu- 
tionized the teaching of veterinary obstetrics even in the 
great schools of Europe. 

9. The only work dealing fuUy with the now no longer 
obscure contagious and infectious diseases of calves. 

10. Absolutely original and no compilation. 

11. The only work dealing fully with the difficult problem 
of teaching obstetrics in the colleges. 

12. The only work where the practical part is not over- 
shadowed by theory. 

... A veterinarian, particularly if his location brings him in 
contact with obstetrical practice, who makes any pretence toward 
being scientific and in possession of modern knowledge upon this 
subject, will not be without this excellent work, as it is really a very 
valuable treatise.— Pro/. Eoscoe E. Bell, in the American Vcterimiry 
Beviciv. 

In translating into English Professor De Bruin's excellent text- 
book on Bovine Obstetrics, Dr. Wyman has laid British and American 
veterinary surgeons and students under a debt of gratitude. The 
works represents the happy medium between the booklets which are 
adapted for cramming purposes by the student, and the ponderous 
tomes which, altliough useful to the teacher, are not exactly suited to 
the requirements of the everyday practitioner . . . We can strongly 
recommend the work to veterinary students and practitioners.- -T/ie 
Journal uf Comparative Pathology and Therapeutics. 

{')DOLLAR. "Diseases of Cattle, Sheep, Goats and 
Swine." By G. Moussu and Jno. A. W. Dollar, 
M.R.C. V.S. Size 6x9 1-2, 785 pages, 329 illustrations 
in the text and 4 full page plates 8 75 

(**)— ''A Hand-book of Horse-Shoeingr," with introductory 
chapters on the anatomy and physiology of the 
horse's foot. By Jno. A. W. Dollar, M.E.C.V.S., 
with the collaboration of Albert Wheatley, F. E.G. V.S. 
Cloth, size 6x8 1-2, 433 pages, 4C6 illustrations . .4 75 

— ** Operatire Teclinique. " Volume 1 of " The Practice of 

Veterinary Surgery." Cloth, size 6 3-4 x 10, 264 pages, 
272 illustrations 3 75 

— *• General Siirgerj'." Volume 2 of " The Practice of Veter- 

inary Surgery." In preparation. 

(*)-" Regional Veterinary Surgery." Volume 3 of "The 
Practice of Veterinary Surgery." By Drs. Jno. A. 
W. Dollar and H. MoUer. Cloth, size 6 1-2 x 10 853 
and xvi pages, 315 illustrations 6 25 



851-853 Sixth Avenue {cor. ^8th St.), New York. 7 

DOLLAR— (continued) 

— "Cadiot's Clinical Veterinary Medicine and Surgery." 

See " Uadiot." 

— "Cadlot's Roaring in Horses." 

See " Cadiot." 

DUN, "Veterinary Medicines, their Actions and Uses." 

By Finlay Dun, V.S., late lecturer on Materia 
Medica and Dietetics at the Edinburgh Veterinary 
College, and Examiner in Chemistry to the Eoyal 
College of Veterinary Surgeons. Edited by James 
Maequeen, F.E.C. V.S. Tenth revised English edition. 
Cloth, size 6x9.... 3 75 

DWYER. ''On Seats and Saddles." Bits and Bitting, 
Draught and Harness and the Prevention and Cure of 
Eestiveness in Horses. By Francis Dwyer. Cloth, 
size 5x7, SOi pages, gilt, illustrated 1 50 

FLEMING. "Animal Plagues." Their History, Nature, 
and Prevention. By Geo. Fleming, F.R.C.V.S., etc. 
First Series. Chronological History from B.C. 1490 

to A.D. 1800. Cloth, size 6x9, 548 pages 6 00 

Second Series. Chronological History from A.D. 
1800 to 1844. Cloth, size 6x9, 539 pages 3 00 

— **Tlie Comparatife Anatomy of the Domesticated Animals." 

By A. Chauveau. Translated by Dr. Fleming. 
See " Chauveau." 

— " The Contagious Diseases of Animals." Their influence on 

the wealth and health of nations and how they are to 
be combated. Paper, size 5x7 1-2, 30 pages 25 

— " Human and Animal Variolae." A Study in Comparative 

Pathology. Paper, size 5 1-2x8 1-2, 61 pages 25 

— "Parasites and Parasitic Diseases of the Domesticated 

Animals." By L. G. Neumann. Translated by 
Dr. Fleming. 

See ^^ Neumann" 



8 Veterinary Catalogue of William R. Jenkins 

FLEMING (continued) 

— "Operative Veteriuary Siirg'erj." Vol. I, by Dr. Geo. 

Fleming, M.R.C.V.S. This valuable work, one of Ihe 
most practical treatises yet Issued on the subject in 
the English language, is devoted to the common opera- 
tions of Veterinary Surgery ; and the concise descrip- 
tions and directions of the test are illustrated with 
numerous wood engravings. Cloth, size 6x9 1-4, 285 
and xviii pages, 343 illustrations 2 75 

(*)Vol. II, edited and passed through the press by 
W. Owen Williams, F.R.C.V.S. Cloth, size 6x9 1-4, 
430 and xxxvii pages, 314 illustrations 3 25 

— " Roaring in Horses." By Dr. George Fleming, 

F.R C.V.S. Its history, nature, causes, prevention 
and treatment. Cloth, size 5 1-2x8 3-4, 160 pages, 21 
engravings, 1 colored plate 1 50 

— "Tuberculosis." From a Sanitary and Pathological Point 

of View. By Geo. Fleming, F.E. C.V.S. Paper, size 
5 1-2x8 1-2, 39 pages 25 

— " Veterinary Obstetrics." Including the Accidents and Dis- 

eases incident to Pregnancy, Parturition, and the Early 
Age in Domesticated Animals. By Geo. Fleming, 
F.R.C.V.S. Cloth, size 6x8 3-4, 758 pages, illus.6 25 

{')GOTTHIEL. "A Manual of General Histology." 

By Wm. S. Gottheil, M D., Professor of Pathology in 
the American Veterinary College, New York; etc., etc. 
Histology is the basis of the physician's art, as 
Anatomy is the foundation of the surgeon's science. 
Only by knowing the processes of life can we under- 
stand the changes of disease and the action of 
remedies ; as the architect must know his building 
materials, so must the practitioner of medicine know 
the intimate structure of the body. To present this 
knowledge in an accessible and simple form has 
been the author's task. Second edition revised. 
Cloth, size 5 1-2 x 8, 152 pages, 68 illustrations. . . 1 00 



851-853 Sixth Avenue {cor. 4Sth St.), New York. 9 

GRESSWELL. " The Bovine Prescribcr." For the use 

of Veterinarians and Velerin.iiy SludentP. Second 
efiition reaped nnd enlarged, by Jrmes B. and Allert 
Qresswell, M.R.C.V.S. Clotii, size, 5x7 1-2, 102 
Piges 75 

— "The Equine Hospital Prescriber." For the use of Veter- 

inary Practitioners and Students. Third edition le- 
vised and enhirged, by Drs. James B. and Ali»ert 
Gresswell, M.R.C.V.S. Cloth, size 5x7 1-2, ICS 
pages 75 

— "Diseases and Disorders of the Horse," A Treatise on 

Equine Medicine and Surgery, being a contribution to 
the science of comparative pathology. By Albert, 
Jas. B. and Geo. Grpsswell. Cloth, size 5 3-4 x 8 3 4, 
227 pages, illusiratcd. . , 1 75 

— Manual of "The Theory and Practice of Equine Medicine." 

By James B. Gresswell, F.E.C.V.S., and Albert 
Gresswell, M.R.C.V.S. Second edition revised. 
Cloth, size 5 1-i x 7 1-2, 539 pages 2 75 

— "Veterinary Pharmacopa)ia .and Manual of Comparative 

Therapy." By George and Charles Gresbwell, with 
descriptions and physiological actions of medicines, 
by Albert Gresswell. Second edition revised and 
enlarged. Cloth, 6x8 3-4, 457 pages 3 CO 

UASSLOCH. " A Compend of Veterinary Materia Medic a 

and Therapeutics." By A. C. Hassloch, V.S., 
Lecturer on Materia Medica and Therapeutics, and 
• Professor of Veterinary Dentistry at the New York 
College of Veterinary Surgeons and School of Compa- 
rative Medicine, N. Y, Cloth, size 5 1-4 x 7 1-2, 225 
pages 1 50 

UEATLEV. " The Stock Owner's Guide." A handy Medi- 
cal Treatise for every man who owns an ox or cow. 
By George S. Heatley, M.R.C.V.S. Cloth, size 
5 1-4 s 8, 172 pages ...1 25 



10 Veterinary Catalogue of William R, Jenkins 

{**)HIL>L. "The Diseases of the Cat." By J. Woodroffe 
Hill, F.E.C.V.S. Cloth, size 5 1-4x7 1-2, 123 pages, 

illustrated 1 25 

Written from the experience of many years' prac- 
tice and close pathological research into the maladies 
to which our domesticated feline friends are liable — a 
subject which it must be admitted has not found the 
prominence in veterinary literature to which it is 
undoubtedly entitled. 

— "The Management and Diseases of the Bog" By J. 

Woodroffe Hill, F.R.C.V.S. Cloth, size 5x7 1-2, 
extra fully illustrated 2 00 

HINEBAUCH, "Veterinary Dental Surgery." By T. D. 

Hinebauch, M.S.V.S. For the use of Students, Prac- 
titioners and Stockmen. Cloth, size 5 1-4 x 8, 256 
pages, illustrated 2 00 

HO AIRE. "A Manual of Veterinary Therapeutics and 
Pharmacology." By E. Wallis Hoare, F.R.C.V.S. 
Cloth, size 5 1-4x7 1-4, 560 pages 2 75 

{*)HOBI>AT. " Canine and Feline Surgery." By Frederick 
T. G. Hobday, F.R.C.V.S. Cloth, 5 3-4x8 3-4, 152 
pfl^s, 76 illustrations 2 GO 

(*)— "The Castration of Cryptorchid Horses and 
the Ovariotomy of Troublesome Mares." By 

Frederick T. G. Hobday, F.R.C.V.S. Cloth, size 
5 3-4x8 3-4, 1C6 pages, 34 illustrations 1 75 

i**)HUNTING. The Art of Horse-shoeing. A manual 
for Horseshoers. By William Hunting, F.R.C.V.S., 
ex-President of the Royal College of Veterinary Sur- 
geons. One of the most up-to-date, concise books of 
its kind in the English language. Cloth, size 6x9 1-4, 
126 pages, 96 illustrations 1 GO 

i**)JENKINS. " Model of the Horse " and " Model of the 
Cow." 

See " Banham," 



851-853 Sixth Avenue (cor. 4Sth St.), New York. 11 

KEATING. "A New Unabridj?ed Pronouncing Diotion- 
ary of Medicine." B3' John M. Keating, M.D., LL.D., 
Henry Hamilton and others. A voluminous and 
exhausiive hand-book of Medical and scientific 
terminology with Piionetic Pronunciation, Accentu- 
ation, Etymology, etc. With an appendix containing 
Important tables of Bacilli, Micrococci, Leuconiaines, 
Ptomaines; Drugs and Materials used in Antiseptic 
Surgery; Poisons and tiieir antidotes; Weights and 
Measures; Themometer Scales; New Officinal anrl 
Unofficinal Drugs, etc., etc. Cloth, 818 pages . . .5 00 

{**)KOBERT. '^Practical Toxicology for Physicians and 

Students." By Professor Dr. Rudolph Robert, 
Medical Director of Dr. Brehmer's Sanitarium for 
Pulmonary Di-^^eases at Goerbersdorf in Silesia (Prus- 
sia), late Director of the Pharmacological Institute, 
Dorpat, Kussia. Translated and edited by L. IT. 
Friedburg, Ph.D. Authorized Edition. Practical 
knowledge by means of tables which occupy little 
space, but show at a glance similarities and differ- 
ences between poisons of the same group. Also rules 
for the Spelling and Pronunciation of Chemical Terms, 
as adopted by the American Association for the Ad- 
vancement of Science. Cloth, 6 1 2 x 10, 201 pp . . 2 50 

KOCH. "Etiology of Tuberculosis." By Dr. R.jKocb. 

Translated by T. Saure. Cloth, size 6x9 1-4, 97 
pages 1 CO 



LAMBERT. "The Werm Theory of Disease." 

Bearing upon the health and welfare of man and the 
domesticated animals. By James Lambert, F.R.C.V.S. 
Paper, size 5 1.4 x 8 1-4, 26 pages, illustrated 25 



LAW. "Farmers' Veterinary Adviser." A Guide to the 
Prevention and Treatment of Disease in Domestic 
Animals. By Prof. James Law. Cloth, size 
5 1-4x7 1-2, illustrated 3 00 



12 Veterinary Catalogue of William R. Jenkins 

{**)LIAUTABD. "Animal Castration." A concise and 

practical Treatise on tlie Castration of the Domestic 

Animals. The only work on the subject in the 

English language. By Alexander Liautard, M.D.,V.S, 

Having a fine portrait of the author. Tenth edition 

revised and enlarged. Cloth, size 5 1-4x7 1-2, 165 

pages, 45 illustrations 2 00 

. . . The most complete and comprehensive work on the 
subject in English veterinary literature.— ^mericau Agri- 
culturist. 

— "Cadiot's Exercises in E(iuine Surgery." Translated by 

Prof. Bitting and edited by Dr. Liautard. 
See " Cadiot." 

— "A Treatise on Surgical Tlierapeutics of the Domestic 

Animals." By Prof. Dr. P. J. Cadiot and J. Almy. 
Translated by Prof. Liautard. 
See " Cadiot." 

— " How to Tell the Age of the Domestic Animal." By 

Dr. A- Liautard, M.D., V.S. Standard work upon 
this subject, concise, helpful and containing many 
illustrations. Cloth, size 5x7 1-2, 35 pages, 42 
illustrations 50 

— "Lameness of Horses and Diseases of the Locomotory 

Apparatus." By A. Liautard, M.D.,V.S. This work 
is the result of Dr. Liautard's many years of experi- 
ence. Cloth, size 5 1-4x7 1-2, 314 pages 2 50 

— "Manual of Operative Teterinary Surgery" By A. 

Liautard, M.D., V.M. Engaged for years in the work 
of teaching this special department of veterinary 
medicine, and having abundant opportunities of 
realizing the difficulties which the student who 
earnestly strives to perfect himself in his calling is 
obliged to encounter, the author formed the deter- 
mination to facilitate his acquisition of knowledge, 
and began the accumulation of material by the com- 
pilation of data and arrangement of memorandum, 
with the lecorded notes of his .own experience, the 
fruit of a long and estenderi practice and a careful 
stuiiy of th« various inithorities who have illustrated 
and organized veteiinary literature. Clolli, size 
G 1-4 X y, 7b(i pages, 5G3 illustrations 5 00 



851-853 Sixth Avenue (cor. 48th St.), New York. ]3 

LIAUTARD (continued). 

— "Pi'llerln's Median Neurotomy in the Treatment of 

Chronic Tendinitis and Periostosis of the Fetlock." 

Translated by Dr. A. Liautard. 
See " Pellerin." 

— "Vade Mocum of Equine Anatomy." By A. Liautard, 

M.D.V.S. For the use of advanced students and 
veterinary surgeons. Third edition. Cloth, size 
5x7 1-2, 30 pages and 10 full page illustrations of 
the arteries 2 00 

— Zimdel's " The Horse's Foot and Its Diseases." 

See " Zundel." 

LONG. "Book of the Pig." Its selection, Breeding, 
Feeding and Management. Cloth 4 00 

(**)LOJVE. "Breeding Racehorses by the Figure 
System." Compiled by the late C. Bruce Lowe. 
Edited by William Allison, " The Special Commis- 
sioner," London Sportsman, Hon. Secretary Sporting 
League, and Manager of the International Horse 
Agency and Exchange. With numerous fine illustra- 
tions of celebrated horses. Cloth, size 8 x IC, 262 
pages • 7 50 

LUDLOW, "Science in the Stable"; or How a Horse 
can be Kept in Perfect Health and be Used Without 
Shoes, in Harness or under the Saddle. With the 
Reason Why. Secon-d Edition. By Jacob R. Ludlow, 
M.D. Late Staff Surgeon, U. S. Army. Paper, size 
4 1-2 X 5 3-4, 166 pages...., 50 

LUPTON. "Horses: Sound and Unsound," with 
Law relating to Sales and Warranty. By J. Irvine 
Lupton, F.U.C.V.S. Cloth, size 5 3-4 x 7 1-2, 2J7 
pages, 2S illustrations 1 25 

MAGNEIt. "Standard Horse and Stock Book." By 

D. Magner. Comprising over 1,000 pages, illustrated 
with 175G engravings. Leather binding G t 



1 1 Veterinary Catalogue of William R. Jenkins 

McBBIDE. "Anatomical Outlines of the Horse." By 

J. A. McBride, M R C.V.S. Second edition revised 
and enlarged. Cloth, size 5 1-4x7 1-4, illus 2 50 

{*)M'FAJDYEAN. "Anatomy of the Horse." Second 
edition completely revised. A Dissection Guide. 
By John M'Fadyean, M.B., B.Sc, F.R.S.E. Cloth, 

size 6x834, 388 pages, illustrated d 50 

This book is intended for Veterinary students, and 
offers to them in its 48 full-page colored plates, 
54 illustrations and excellent text, a valuable and 
practical aid in the study of Veterinary Anatomy, 
especially in the dissecting room. 

— '* Comparatire Anatomy of the Domesticated Animals." 

By J. M'Fadyean. Profusely illustrated, and to be 

issued in two parts. 

Part I— Osteology, ready. Size 5 1-2x8 1-2, 166 

pages, 132 illustrations. Paper, 2 50; cloth 2 75 

(Part II in preparation.) 

MILLS. "How to Keep a Dog in the City." By 

Wesley Mills, M.D., D.V.S. It tells how to choose, 
manage, house, feed, educate the pup, how to lieep him 
clean and teach him cleanliness. Paper, size 5x7 1-2, 
40 pages 26 

OMOLLEM — DOLLAR. "Regional Veterinary 

Surgery," See " Dollar." 

MOHLEB. "Handbook of Meat Inspection." By Robert 
Ostertag, M.D. Translated by Earley Vernon 
Wilcox, A.M., Ph.D. With an introduction by 
John R. Mohler, V.M.D., AM. See '» Ostertag." 

MOSSELMAIf-LlENAUX. ''Manual of Veterinary 
Microbiology." By Professors Mosselman and 
Lienaux, Nat. Veterinary College, Cureghem, Belgium. 
Translated and edited by R. R. Dinwiddle, Professor 
of Veterinary Science, College of Agriculture, Arkansas 
State University. Cloth, size 5 1-2 x 8, 342 pages, 
illustrated 2 00 



851-853 Sia;th Avenue (oor. 48th St.), New York. 15 

OMOUSSU. "Diseases of Cattle, Sheep, Goats and 

Swine." 

See " Dollar." 

{')NEUMANN. "A Treatise on Parasites and Parasitic 
Diseases of tlie Domesticated Animals." A work 
to which the students of human or veterinary medi- 
cine, the sanitarian, agriculturist or breeder or rearer 
of animals, may refer for full information regarding 
the external and internal Parasites— vegetable and 
animal — which attack various species of Domestic 
Animals. A Treatise by L, G. Neumann, Professor 
at the National Veterinary School of Toulouse. 
Translated and edited by Geo. Fleming, C.B., LL.D., 
F.R G.V.S. Second edition, revised and edited by 
James Macqueen, F.R.C.V.S., Professor at the Royal 
Veterinary College, London. Cotb, size 6 3-4 x 10, 
xvi + 698 pages, 365 illustrations 6 75 

NOCABD. " The Animal Tuberculoses, and their Relation 
to Human Tuberculosis." By Ed. Nocard, Prof, of the 
Alfort Veterinary College. Translated by H. Scurfield, 
M.D. Ed., Ph. Camb. Cloth, 5 x7 1-2, 143 pages.. 1 00 
Perhaps the chief interest to doctors of human 
medicine in Professor Nocard's book lies in the 
demonstration of the small part played by heredity, 
and the great part played by contagion in the propa- 
gation of bovine tuberculosis. It seems not unreason- 
able to suppose that the same is the case for human 
tuberculosis, and that, if the children of tuberculous 
parents were protected from infection by cohabitation 
or ingestion, the importance of heredity as a cause of 
the disease, or even of the predisposition to it, would 
dwindle away into insignificance. 

OOSTEBTAG. " Handbook of Meat Inspection." By 

Robert Ostertag, M.D. Authorized Translation by 
Earley Vernon Wilcox, A.M., Ph.D. With an intro- 
duction by John R. Mohler, V.M.D., A.M. The work 
is exhaustive and authorative and has at once become 
the standard authority upon the subject Second 
edition, revised 1905. Cloth, size 6 3-4x9 3-4, 920 
pages, 260 illustrations and 1 colored plate 7 50 



16 Veterinary Catalogue of William R, Jenkins 

{*)PALLIN, " A Treatise on Epizootic Lympliangitis." By 

Capt. W. A. Palliu, F.K,C,V.S. In this work the 
author has endeavored to combine his own experience 
with that of other writers and so attempts to give a 
clear and complete account of a subject about which 
there is little at present in English veterinary litera- 
ture. Cloth, size 5 3-4x8 1-2, 90 pages, with 17 fine 
full page illustrations 1 25 

PEOLEIt. "The Book of the Goat." Third edition re- 
written and enlarged. Cloth, 223 pages, illus 1 75 

PELLEHIJSr, "Median Neurotomy in the Treatment 
of Chronic Tendinitis and Periostosis of the Fetlock." 

By C. Pellerin, late repetitor of Clinic and Surgery to 
the Alfort Veterinary School. Translated, with Addi- 
tional Facts Kelating to It, by Prof. A. Liautard, M.D., 
V.M. Having rendered good results when performed 
by himself, the author believes the operation, which 
consists in dividing the cubito-plantar nerve and in 
excising a portion of the peripherieal end, the means 
of improving the conditions, and consequently the 
values of many apparently doomed animals. Agricul- 
ture in particular will be benefited. 

The work is divided into two parts. The first covers 
the study of Median Neurotomy itself ; the second, 
the exact relations of the facts as observed by the 
author. Boards, 6x9 1-2, 61 pages, illustrated. .1 00 

PETERS. " A Taherculous Herd— Test with Tuber- 
culin." By Austin Peters, M. K. C. V. S., Chief 
Inspector of Cattle for the New York State Board of 
Health during the winter of 1892-93. Pamphlet. . . .25 

REYNOLDS. "An Essay on the Breeding and Manage- 
ment of DraugJit Horses." By E. S. Keynolds, 
M.B.C. V.S. Cloth, size 5 1-2x8 3-4, 104 pages. . 1 40 

ROBERGE. "The Foot of the Horse," or Lameness 
and all Diseases of the Feet traced to an Unbalanced 
Foot Bone, prevented or cured by balancing the foot. 
By David Eoberge. Cloth, size 6x9 1-4, 308 pages, 
illustrated 5 00 



851-853 Sixth Avenue {cor. ASth St.), New York. 17 

i*)SESS10NS. " Cattle Tuherculosis," a Practical Guide to 
tlie Agricultui'ist and Inspector. By Harold Ses&ions, 
F.E.C.V.S., etc. Second edition. Size 5x7 1-4, vi + 
120 pages 1 00 

The object of the author has been to write the text 
in such a manner that the subject can be understood 
by those who have to deal particularly with it. yet 
who, perhaps, have not had the necessary training to 
appreciate technical phraseology. 

SEWELL. "The Examination of Horses as to Sound- 
ness and Selection as to Purchase." By Edward 
Sewell, M.E.C.V.S. Paper, size 5 1-2 x 81 2, 86 pages, 
illustrated with 8 plates in color 1 £0 

— It is a great advantage to the business man to 
know something of the elements of law, and nobody 
ought either to buy or own a horse who does not know 
something about the animal. That something this book 
gives, and gives in a thoroughly excellent way . . . 

— Our Annual Friends. 

SMITH. *'A Manual of Veterinary Physiology." By 

Col. F.Smith, CM.S., F.E.C.V.S.. F.I.C., author of 
" A Manual of Veterinary Hygiene." 

Throughout this manual the object has been to con- 
dense the information as much as possible. The 
broad facts of the sciences are stated so as to render 
them of use to the student and practitioner. In this 
second edition — rewritten — the whole of the Nervous 
System has been revised, a new chapter dealing with 
the Development of the Ovum has been added together 
with many additional facts and illustrations. About 
one hundred additional pages are given. Secovd 
edition, revised and enlarged. Cloth, size 6x8 3-4, 
573 pages, 102 illustrations 3 75 

— (*)" Manual of Veterinary Hygiene." Third edition revised. 
Cloth, size 5 1-4x7 1-2, xx + If 36 pages, with 255 
illustrations 4 75 

Kecognizing the rapid advance and extended field 
of the subject since the previous issue, the author 
has entirely re-written the work and enlarged its 
scope, which is brought thoroughly up to date. Con- 
tains over 500 more pages than the second edition. 

(**)STBANGEWAT. "Veterinary Anatomy." Edited by 
I. Vaughan, F.L.S., M.E.C.V.S. New edition revised. 
Cloth, size 6 1-4x9 1-2, 625 pages, 224 illus 5 00 



18 Veterinary Catalogue of William It, Jenkim 

SUSSnOBF. " Six Large Colored Wall Diagrams." By 

Prof. Sussdorf, M.D, (of Gottingeii). Text translated 
by Prof. W. Owen Williams, of the New Veterinary 
College, Edinburgh. Size, 44 inches by 30 inches. 

1.— Horse. 4.— Ox, 

2.— Mare. 5.— Boar and Sow. 

3.— Cow. 6.— Dog and Bitch. 

The above are printed in eight or nine colors. 
Showing the position of the viscera in the large 
cavities of the body. 

Price, unmounted 1 75 each 

" mounted on linen, with roller 3 50 " 

i**)THOMPSON. "Elementary Lectures on Veterinary 
Science." For agricultural students, farmers and 
stock keepers. By Henry Thompson, M.R.O.V.S., 

lecturer on Veterinary Science at the Aspatria Agri- 
cultural College, England. It is complete yet concise 
and an up-to-date book. Cloth, 397 pp., 51 illus..3 75 

VAN MATEB, " A Text Book of Veterinary Oph- 
thalmology." By George G. Van Mater, M.D., 
D.V.S., Professor of Ophthalmology in the American 
Veterinary College ; Oculist and Auristto St. Martha's 
Sanitarium and Dispensary ; Consulting Eye and Ear 
Surgeon to the Twenty-sixth Ward Dispensary ; Eye 
and Ear Surgeon, Brooklyn Eastern District Dispen- 
sary, etc. Illustrated by one chromo lithograph plate 
and 71 engravings. Cloth, 6x9 1-4, 151 pages.. .3 00 

. . . We intend to adopt this valuable work as a text 
book.— E. J. Creely, D.V.S., Dean of the San Francisco 
Veterinary College. 

VETEBlNAItY DIAGRAMS in Tabular Form. 

Size, 28^ in. x 22 inches. Price per set of five 4 GO 

Mounted and folded in case 7 00 

Mounted on roller and varnished 10 00 

No. 1 "The External Form and Elementary Ana- 
tomy of the Horse." Eight colored illustrations — 
1. External regions ; 2. Skeleton : 3. Muscles (Superior 
Layer); 4. Muscles (Deep Layer); 5. Respiratory Ap- 



851-853 Sixth Avenue (cor. mh St.), New York. 19 

VETEKINARY DIAGRAMS (continued). 

paratus ; 6. Digestive Apparatus ; 7. Circulatory Ap- 
paratus ; 8. Nerve Apparatus ; withi letter-press descrip- 
tion 1 25 

Mounted on roller and varnished 2 25 

No. 2. "The Age of Domestic Animals." Forty-two 
figures illustrating the structure of the teeth, indicat- 
ing the Age of the Horse, Ox, Sheep, and Dog, with 

full description 75 

Mounted on roller and varnished 2 00 

No. 3. "The Unsoundness and Defects of the Horse." 

Fifty figures illustrating— 1. The Defects of Confor- 
mation ; 2. Defects of Position ; 3. Infirmities or Signs 
of Disease ; 4. Unsoundnesses ; 5. Defects of the Foot ; 

with full description 75 

Mounted on roller and varnished 2 00 

No. 4. ".The Shoeing of the Horse, Mule and Ox." 

Fifty figures descriptive of the Anatomy and Physio- 
logy of the Foot and of Horse-shoeing 75 

Mounted on roller and varnished 2 00 

No. 5. "The Elementary Anatomy, Points, and But- 
cher's Joints of the Ox." Ten colored illustrations 
— 1. Skeleton; 2. Nervous System; 3. Digestive 
System (Right Side) ; 4. Respiratory System ; 5. Points 
of a Fat Ox ; 6. Muscular System ; 7. Vascular System ; 

, 8. Digestive System (Left Side) ; 9. Butcher's Sections 
of a Calf ; 10. Butcher's Sections of an Ox ; with full 

descriptionj 1 25 

Mounted on roller and varnished 2 25 



VFALLET, "Four Boyine Scourges." (Pleuro-Pneumonla, 
Foot and Mouth Disease, Cattle Plague and 
Tubercle). By Thomas Walley, M.R.C.V.S. With 
an Appendix on the Inspection of Live Animals and 
Meat. Quarto, cloth 6 40 



20 Veterinary Catalogue of William R. Jenkins 

WALLEY (continued). 

(*)— "A Practical Guide to Meat Dispection." By 

Thomas Walley, M.R.C.V.S., late principal of the 
Edinburgh Royal (Dick) Veterinary College; Pro- 
fessor of Veterinary Medicine and Surgery, etc. 
Fourth Edition, thoroughly revised and enlarged 
by Stewart Stockman, M.R.C.V.S., Professor of 
Pathology, Lecturer on Hygiene and Meat Inspection 
at Dick Veterinary College, Edinburgh. Cloth, size 
5 1-2x8 l-'4, with 45 colored illus., 295 pages 3 00 

An experience of over 30 years in his profession 
and a long ofBcial connection (some sixteen years) 
with Edinburgh Abattoirs have enabled the author to 
gather a large store of information on the subject, 
which he has embodied in his book. 

While Dr. Stockman is indeed indebted to the 
old for much useful information, tJiis up-to- 
date work will hardly be recognized as the old 
" VValley's Meat Inspection." 



IVILCOX. '* Handbook of Meat Inspection." By Robert 
Ostertag, M.D. 

See " Ostertag." 



WILLIAMS. "Principles and Practice of Teterinary 
Medicine." Author's edition, entirely revised and 
illustrated with numerous plain and colored plates. 
By W. Williams, M.R.C.V.S. Cloth, size 5 3-4x8 3-4, 
865 pages.... 7 50 



— " Principles and Practice of Veterinary Surgery." 

Author's edition, entirely revised and illustrated 
with numerous plain and colored plates. By W. 
Williams, M.R.C.V.S. Cloth, size 6 1-2x9 1-4, 756 
pages 7 50 



851-853 Sixth Avenue {cor. iSth St.), New York 21 

THE MOST COMPLETE, PROGRESSIVE AND 
SCIENTIFIC BOOK ON THE SUBJECT IN 
THE ENGLISH LANGUAGE 

(•) WINSLO W. "Veterinary Materia Modica and Tiierapoii- 
tics." By Kenelra Winslow. B.A.S., M.D.V., M.D., 
(Harv.) ; formerlj- Assistant Professor of Therapeutics 
ia the Veterinary School of Harvard University ; 
Fellow of tiie Massachusetts Medical Society ; Surgeon 
to the Newton Hospital, etc. 

Third Edition, Revised i905 

Cloth, size 6 1-4 x 9 1-1, viii -f 804 pages 6 00 

Your letter received and I am pleased to know that we are to 
have an American Materia Medica.— J. H. JVattles, Sr., M.D., D.V.S., 
The Western Veterinary College, Kansas City, Mo. 

. . . Am delighted with it. It is remarkably correct, complete 
and up-to-dale and is bound to supersede any other work on the same 
subject heretofore before the profession. 

No practitioner's library is complete without it and it will be 
indispensable for students, as it does aWay with the necessity of their 
having a number of collateral books on the subject. 

It will be adopted as the text book in the Chicago Veterinary 
College.— Dr. E. L. Quitman, Chicago Veterinary College. 

. . . The book is of admirable merit and full of valuable informa- 
tion from beginning to end, very explicit, rich and interesting, and 
should be in the hands of every student as well as practitioner of the 
. art of Veterinai-y Medicine.— T/nusfoH Miller, M.D., Professor of 
Materia Medica, Therapeutics and Chemistry, San Francisco Veteri- 
nary College. 

I consider it the only work on materia medica and therapeutics 
suitable to the American veterinary practitioner. It deserves a wide 
distribution among veterinarians. I have recommended it to my 
Students.— Jo/i)i J. Repp, V.M.D., Iowa State College, Ames, Iowa. 



22 Veterinary Catalogue of William R. Jenkins. 

{*)WTMAN. "BoTine Obstetrics." By M. G. De Bruin. 
Translated by W. E. A. Wyman, M.D.V.,V.S. 
See also " De Bruin." 

(•)— "Catechism of tlie Principles of Veterinary Surgery." 

By W. E. A. Wyman, M.D.V.,V.S. Cloth, size 6x9, 
321 pages 3 50 

Concerning this new work attention is called to tlie 
followinsr points : 

1.— It discusses the subject upon the basis of veterinary investigations. 

2. — It does away with works on human pathology, histology, etc. 

3. — It explains each question thoroughly both from a scientific as well 

as a practical point of view. 
4. — It is writen by one knowing the needs of the student. 
5. — It deals exhaustively with a chapter on tumors, heretofore utterly 

neglected in veterinary pathology. 
6. — The only work in English specializing the subject. 
7.— The only work thoroughly taking into consideration American as 

well as European investigations. 
8.— Offering practical hints which have not appeared in print, the 

result of large city and country practice. 

(*•)_" Xlie Clinical Diagnosis of Lameness in the Horse." 

By W. E. A. Wyman, D.V.S., formerly Professor of 
Veterinary Science, Clemson A. & M. College, and 
Veterinarian to the South Carolina Experiment 
Station. Cloth, size 6x9 1-2, 182 pp., 32 illus. . . .2 50 

(•)— " Tibio-peroneal Neurectomy for the Relief of Spaviu 

Lameness." By W. E. A. Wyman, M.D.V., V.S. 

Boards, size 6 x 9, 30 pages, illustrated 50 

Anyone wanting to perform this operation should procure 
this little treatise ; he will find it of considerable help.— The 
Vet&rinary Journal. 

ZUNDEL. "The Horse's Foot and Its Diseases." By 

A. Zundel, Principal Veterinarian of Alsace Lorrain © 
Translated by Dr. A. Liautard, V.S. Cloth, size 
5x7 3-4, 248 pages, illustrated 2 00 

ZUILL, "Typhoid Fever; or Contagions Influenza 
in the Horse." By Prof. W. L. Zuill, M.D.,D.V.S. 
Pamphlet, size 6 x 9 1-4, 29 pages 25 



Any book sent prepaid for the price 

WILLIAfl R. JENKINS, 

851 and 853 Sixtli Avenue, NEW^ YORK. 



LIBRARY OF CONGRESS 



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